Provider Demographics
NPI:1679957716
Name:HEISER, BRET JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:BRET
Middle Name:JOSEPH
Last Name:HEISER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20920 CALIFORNIA CIR STE A600
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-4165
Mailing Address - Country:US
Mailing Address - Phone:402-217-9555
Mailing Address - Fax:
Practice Address - Street 1:20920 CALIFORNIA CIR STE A600
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-4153
Practice Address - Country:US
Practice Address - Phone:402-217-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-18
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007320111N00000X
NE1945111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor