Provider Demographics
NPI:1710013719
Name:VAN HEMERT CHIROPRACTIC CENTER, P.C.
Entity Type:Organization
Organization Name:VAN HEMERT CHIROPRACTIC CENTER, P.C.
Other - Org Name:RUSSELL R VAN HEMERT
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:R
Authorized Official - Last Name:VAN HEMERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:641-628-2099
Mailing Address - Street 1:1310 WASHINGTON ST
Mailing Address - Street 2:PO BOX 26
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1512
Mailing Address - Country:US
Mailing Address - Phone:641-628-2099
Mailing Address - Fax:641-628-2324
Practice Address - Street 1:1310 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1512
Practice Address - Country:US
Practice Address - Phone:641-628-2099
Practice Address - Fax:641-628-2324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04934111NS0005X
IAA076744363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA23195OtherBCBS PROVIDER #
IA0231951Medicaid
IA1497758676OtherNPI INDIVIDUAL NUMBER
IAI11623Medicare ID - Type UnspecifiedMEDICARE ORGANIZATION NUM
IA23195OtherBCBS PROVIDER #