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General NPI Number Information
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NPI Number | 1518007756
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Entity Type | Organization
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Legal Business Name | HEINEN CHIROPRACTIC, SC
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2103 INDIANA AVE STE 1A
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City | SHEBOYGAN
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State | WI
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Zip | 53081-4729
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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 | 2103 INDIANA AVE STE 1A
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City | SHEBOYGAN
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State | WI
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Zip | 53081-4729
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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 | PRESIDENT
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Name | DR. KENNETH SCOTT HEINEN
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Credential | D.C.
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Telephone | 920-451-9960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | WI
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