Provider Demographics
NPI:1093934010
Name:HEAGY, DANITA THOMAS (DC)
Entity Type:Individual
Prefix:
First Name:DANITA
Middle Name:THOMAS
Last Name:HEAGY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 US 1 SOUTH
Mailing Address - Street 2:DANITA THOMAS HEAGY DC LLC SUITE 109
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-7280
Mailing Address - Country:US
Mailing Address - Phone:904-797-5100
Mailing Address - Fax:904-797-5033
Practice Address - Street 1:4425 US 1 SOUTH
Practice Address - Street 2:DANITA THOMAS HEAGY DC LLC SUITE 109
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-7280
Practice Address - Country:US
Practice Address - Phone:904-797-5100
Practice Address - Fax:904-797-5033
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4199111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
88095Medicare UPIN