Provider Demographics
NPI:1992803209
Name:HEARTLAND CHIROPRACTIC CLINIC OF MORTON
Entity type:Organization
Organization Name:HEARTLAND CHIROPRACTIC CLINIC OF MORTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-284-0494
Mailing Address - Street 1:658 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-1536
Mailing Address - Country:US
Mailing Address - Phone:309-284-0494
Mailing Address - Fax:309-284-0385
Practice Address - Street 1:658 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-1536
Practice Address - Country:US
Practice Address - Phone:309-284-0494
Practice Address - Fax:309-284-0385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042617554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09032019OtherBLUE CROSS BLUE SHIELD
IL9266250OtherPHCS
IL356344200OtherFEDERAL WORK COMP
IL205124Medicare ID - Type UnspecifiedMEDICARE GROUP
IL09032019OtherBLUE CROSS BLUE SHIELD