Provider Demographics
NPI:1023187226
Name:HEINZ, JARED BENJAMIN (DC)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:BENJAMIN
Last Name:HEINZ
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 1:1436A PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2134
Mailing Address - Country:US
Mailing Address - Phone:610-375-1411
Mailing Address - Fax:610-375-1366
Practice Address - Street 1:1436A PENN AVE
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2134
Practice Address - Country:US
Practice Address - Phone:610-375-1411
Practice Address - Fax:610-375-1366
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009691111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor