Provider Demographics
NPI:1114688140
Name:MOE, HEIDI LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:LYNN
Last Name:MOE
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 1:3774 NORWAY LN APT 421
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-9855
Mailing Address - Country:US
Mailing Address - Phone:320-808-7980
Mailing Address - Fax:
Practice Address - Street 1:1405 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5725
Practice Address - Country:US
Practice Address - Phone:812-373-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003274A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor