Healthcare Provider Details

I. General information

NPI: 1356651483
Provider Name (Legal Business Name): HIEBNER CHIROPRACTIC CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 LAKE AVE
GOTHENBURG NE
69138-1943
US

IV. Provider business mailing address

815 LAKE AVE
GOTHENBURG NE
69138-1943
US

V. Phone/Fax

Practice location:
  • Phone: 308-537-3691
  • Fax: 308-537-3691
Mailing address:
  • Phone: 308-537-3691
  • Fax: 308-537-3691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1061
License Number StateNE

VIII. Authorized Official

Name: DR. ROYCE LYDELL HIEBNER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 308-537-3691