Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 651 | NE |
NPI | 1003816919 |
---|---|
Provider Name | Dr. Randy Ralph Hinze |
First Address | Columbus, NE 68601-3305 |
Second Address | Columbus, NE 68601-3305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 25/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
092170 | PTAN (01) | NE |
47063696713 | (05) | NE |
9515 | BLUE CROSS BLUE SHIELD (01) | NE |
T74880 | (02) |