Provider Demographics
NPI:1295069433
Name:HEINEN CHIROPRACTIC, S.C.
Entity type:Organization
Organization Name:HEINEN CHIROPRACTIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDEE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-452-9967
Mailing Address - Street 1:1539 N 33RD PL
Mailing Address - Street 2:SUITE B
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-1826
Mailing Address - Country:US
Mailing Address - Phone:920-451-9960
Mailing Address - Fax:920-451-9965
Practice Address - Street 1:1539 N 33RD PL
Practice Address - Street 2:SUITE B
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-1826
Practice Address - Country:US
Practice Address - Phone:920-451-9960
Practice Address - Fax:920-451-9965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3643-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38927500Medicaid
WI000035269Medicare PIN
WIU81839Medicare UPIN