Provider Demographics
NPI:1114090164
Name:BACH-HEITNER, DONNA JO (DC)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:JO
Last Name:BACH-HEITNER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DONNA
Other - Middle Name:J
Other - Last Name:BACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:202 VINCENT DR
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-2425
Mailing Address - Country:US
Mailing Address - Phone:516-794-3600
Mailing Address - Fax:516-794-3609
Practice Address - Street 1:202 VINCENT DR
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2425
Practice Address - Country:US
Practice Address - Phone:516-794-3600
Practice Address - Fax:516-794-3609
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3455111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC03455-5OtherWORKERS COMPENSATION
P643908OtherOXFORD
51568OtherVYTRA
X23771OtherBLUE CROSS BLUE SHIELD
T52763Medicare UPIN
NYC03455-5OtherWORKERS COMPENSATION