MEDICARE: HEARTLAND CHIROPRACTIC CLINIC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN0400X	Neurology Chiropractor	1071	NE

General Provider Information

NPI Number	:	1740496116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND CHIROPRACTIC CLINIC PC

Provider Business Mailing Address
First Line	:	2418 CORNHUSKER RD
Second Line	:
City	:	BELLEVUE
State	:	NE
Zip	:	68123-2412
Country	:	US
Telephone Number	:	402-291-2121
Fax Number	:	402-291-8957

Provider Business Practice Location Address
First Line	:	2418 CORNHUSKER RD
Second Line	:
City	:	BELLEVUE
State	:	NE
Zip	:	68123-2412
Country	:	US
Telephone Number	:	402-291-2121
Fax Number	:	402-291-8957

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS LEE SMITH
Credential	:	DC
Telephone Number	:	402-291-2121

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	08/22/2020

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