Provider Demographics
NPI:1891196721
Name:HEIB CHIROPRACTIC INC
Entity Type:Organization
Organization Name:HEIB CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEIB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-324-0100
Mailing Address - Street 1:2225 E CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-4421
Mailing Address - Country:US
Mailing Address - Phone:269-324-0100
Mailing Address - Fax:269-324-5295
Practice Address - Street 1:2225 E CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-4421
Practice Address - Country:US
Practice Address - Phone:269-324-0100
Practice Address - Fax:269-324-5295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6816111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C950094952OtherMEDICARE ID- TYPE UNSPECIFIED
MI269464414Medicaid
MI269464414Medicaid