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General NPI Number Information
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NPI Number | 1295069433
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Entity Type | Organization
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Legal Business Name | HEINEN CHIROPRACTIC, S.C.
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Dates
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Enumeration Date | 09/21/2009
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Last Update Date | 10/03/2014
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Provider Practice Location Address
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Address Line | 1539 N 33RD PL SUITE B
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City | SHEBOYGAN
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State | WI
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Zip | 53081-1826
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Country | US
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Telephone | 920-451-9960
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Fax | 920-451-9965
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Provider Business Mailing Address
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Address Line | 1539 N 33RD PL SUITE B
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City | SHEBOYGAN
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State | WI
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Zip | 53081-1826
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Country | US
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Telephone | 920-451-9960
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Fax | 920-451-9965
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | WENDEE J HAUCH
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Credential |
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Telephone | 920-452-9967
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3643-012
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License Number State | WI
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