Provider Demographics
NPI:1780744771
Name:HEINTZKILL CHIROPRACTIC PLUS LLC
Entity type:Organization
Organization Name:HEINTZKILL CHIROPRACTIC PLUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:KEINTZKILL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-337-9003
Mailing Address - Street 1:566 REDBIRD CIRCLE
Mailing Address - Street 2:#7
Mailing Address - City:DEPERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-8796
Mailing Address - Country:US
Mailing Address - Phone:920-337-9003
Mailing Address - Fax:920-337-9003
Practice Address - Street 1:566 REDBIRD CIRCLE
Practice Address - Street 2:#7
Practice Address - City:DEPERE
Practice Address - State:WI
Practice Address - Zip Code:54115-8796
Practice Address - Country:US
Practice Address - Phone:920-337-9003
Practice Address - Fax:920-337-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1697012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty