Provider Demographics
NPI:1003880253
Name:HEFFRON, LAWRENCE E (DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:E
Last Name:HEFFRON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52544-1708
Mailing Address - Country:US
Mailing Address - Phone:641-437-4278
Mailing Address - Fax:641-856-5747
Practice Address - Street 1:116 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-1708
Practice Address - Country:US
Practice Address - Phone:641-437-4278
Practice Address - Fax:641-856-5747
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05005111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0213025Medicaid
IA0213025Medicaid
IAI9187Medicare PIN