Individual provider Active NPI

Kenneth S Heinen, DC

  • Chiropractor
  • Sheboygan, WI
National Provider Identifier
1417094368
Registry record updated Dec 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3643-012 Issued in WI
Practice address
1539 33Rd Place
Suite B
Sheboygan, WI 53081-1826
Phone
(920) 451-9960
Fax
(920) 451-9965
NPI assigned
Jan 31, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 18, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3643-012 WI Primary

Addresses

Primary practice location

1539 33Rd Place
Suite B
Sheboygan, WI 53081-1826

Mailing address

1539 33Rd Place
Suite B
Sheboygan, WI 53081-1826
Phone (920) 451-9960

Other identifiers 1

IdentifierTypeStateIssuer
38927500MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091008000038 WI Practitioner - Chiropractic 9032255898 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1539 N 33Rd PL
Suite B
Sheboygan, WI 53081-1839
Phone (920) 451-9960

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3643-012WIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Heinen Chiropractic, SC Current Accepting new patients
Heinen Chiropractic, S.C. Chiropractor CurrentSince Oct 24, 2000 Accepting new patients

Locations

1539 N 33rd Pl
Ste B
Sheboygan, WI 53081
Phone (920) 451-9960

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387324800000",
    "number": "1417094368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1539 33RD PLACE",
            "address_2": "SUITE B",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530811826",
            "telephone_number": "920-451-9960",
            "fax_number": "920-451-9965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1539 33RD PLACE",
            "address_2": "SUITE B",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530811826",
            "telephone_number": "920-451-9960",
            "fax_number": "920-451-9965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEINEN",
        "first_name": "KENNETH",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2013-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3643-012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38927500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sheboygan, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.