Provider Demographics
NPI:1033885538
Name:100 CHIRO HEIM 1, LLC
Entity Type:Organization
Organization Name:100 CHIRO HEIM 1, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRANCHISEE
Authorized Official - Prefix:
Authorized Official - First Name:JEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-217-0895
Mailing Address - Street 1:1805 E WILLIAMS FIELD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-5324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1805 E WILLIAMS FIELD RD STE 101
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-5324
Practice Address - Country:US
Practice Address - Phone:719-217-0895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty