MEDICARE: RUSSELL GENE HELLER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	974	NE
2	111N00000X	Chiropractor	5802	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	27355	OTHER	NE	BCBS

General Provider Information

NPI Number	:	1598766586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL GENE HELLER D.C.

Provider Business Mailing Address
First Line	:	528 N 4TH ST
Second Line	:
City	:	DAVID CITY
State	:	NE
Zip	:	68632-1624
Country	:	US
Telephone Number	:	402-367-6061
Fax Number	:	402-367-4220

Provider Business Practice Location Address
First Line	:	528 N 4TH ST
Second Line	:
City	:	DAVID CITY
State	:	NE
Zip	:	68632-1624
Country	:	US
Telephone Number	:	402-367-6061
Fax Number	:	402-367-4220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	07/22/2011

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