Provider Demographics
NPI:1083786859
Name:HEIMAN, JAMIE (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:
Last Name:HEIMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:HOLLIS-HEIMEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4100 DEWEY ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-5497
Mailing Address - Country:US
Mailing Address - Phone:920-686-5700
Mailing Address - Fax:920-686-5726
Practice Address - Street 1:4100 DEWEY ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-5497
Practice Address - Country:US
Practice Address - Phone:920-686-5700
Practice Address - Fax:920-686-5726
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3816-012111N00000X
WI7455363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI161708205012OtherBCBS
WI161708205012OtherBCBS
WI000133055Medicare ID - Type UnspecifiedMEDICARE PROVIDER #