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General NPI Number Information
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NPI Number | 1710013719
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Entity Type | Organization
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Legal Business Name | VAN HEMERT CHIROPRACTIC CENTER, P.C.
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 1310 WASHINGTON ST
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City | PELLA
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State | IA
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Zip | 50219-1512
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Country | US
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Telephone | 641-628-2099
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Fax | 641-628-2324
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Provider Business Mailing Address
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Address Line | 1310 WASHINGTON ST PO BOX 26
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City | PELLA
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State | IA
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Zip | 50219-1512
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Country | US
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Telephone | 641-628-2099
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Fax | 641-628-2324
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Authorized Official
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Title or Position | OWNER
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Name | DR. RUSSELL R VAN HEMERT
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Credential | D.C.
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Telephone | 641-628-2099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | A076744
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 04934
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License Number State | IA
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