Healthcare Provider Details

I. General information

NPI: 1790887917
Provider Name (Legal Business Name): ROYCE LYDELL HIEBNER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 9TH ST
GOTHENBURG NE
69138
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: 308-537-3062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: