Provider Demographics
NPI:1790887917
Name:HIEBNER, ROYCE LYDELL (DC)
Entity Type:Individual
Prefix:MR
First Name:ROYCE
Middle Name:LYDELL
Last Name:HIEBNER
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 1:815 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:GOTHENBURG
Mailing Address - State:NE
Mailing Address - Zip Code:69138-1943
Mailing Address - Country:US
Mailing Address - Phone:308-537-3691
Mailing Address - Fax:308-537-3062
Practice Address - Street 1:417 9TH ST
Practice Address - Street 2:
Practice Address - City:GOTHENBURG
Practice Address - State:NE
Practice Address - Zip Code:69138
Practice Address - Country:US
Practice Address - Phone:308-537-3691
Practice Address - Fax:308-537-3691
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1061111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE350093505OtherMEDICARE RAILROAD
87043OtherFIRST HEALTH DIRECT
NE9812OtherBCBS
NE47081586300Medicaid
71079OtherPIONEER HEALTH PLAN
NE11576OtherMIDLANDS CHOICE
60054OtherAETNA
62308OtherCIGNA HEALTHCARE
NE87042OtherUPREHS
37257OtherEMPLOYEE BENEFIT CON
87726OtherUNITED HEALTHCARE
62308OtherCARE MARK INC
62308OtherCARE MARK INC
NE47081586300Medicaid