Provider Demographics
NPI:1235104910
Name:HEISE, FORREST JOHN (DC)
Entity Type:Individual
Prefix:MR
First Name:FORREST
Middle Name:JOHN
Last Name:HEISE
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 1:2930 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-1616
Mailing Address - Country:US
Mailing Address - Phone:319-754-5751
Mailing Address - Fax:319-758-6479
Practice Address - Street 1:2930 DIVISION ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-1616
Practice Address - Country:US
Practice Address - Phone:319-754-5751
Practice Address - Fax:319-758-6479
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0024927Medicaid
T00308Medicare UPIN
02492Medicare ID - Type Unspecified