Provider Demographics
NPI:1700100666
Name:HEARTLAND CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:HEARTLAND CHIROPRACTIC, LLC
Other - Org Name:HEARTLAND CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORIN
Authorized Official - Middle Name:SHAE
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:325-641-2541
Mailing Address - Street 1:919 EARLY BLVD
Mailing Address - Street 2:STE 1C
Mailing Address - City:EARLY
Mailing Address - State:TX
Mailing Address - Zip Code:76802
Mailing Address - Country:US
Mailing Address - Phone:325-641-2541
Mailing Address - Fax:
Practice Address - Street 1:919 EARLY BLVD
Practice Address - Street 2:STE 1C
Practice Address - City:EARLY
Practice Address - State:TX
Practice Address - Zip Code:76802
Practice Address - Country:US
Practice Address - Phone:325-641-2541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND CHIROPRACTIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty