Provider Demographics
NPI:1093952822
Name:HEIDINGSFELDER, ADAM J (DC)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:J
Last Name:HEIDINGSFELDER
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 1:19009 PINEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-4540
Mailing Address - Country:US
Mailing Address - Phone:228-864-9200
Mailing Address - Fax:228-864-9222
Practice Address - Street 1:19009 PINEVILLE RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-4540
Practice Address - Country:US
Practice Address - Phone:228-864-9200
Practice Address - Fax:228-864-9222
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor