Provider Demographics
NPI:1336326800
Name:HEATON FAMILY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:HEATON FAMILY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HEATON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-883-8100
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-0189
Mailing Address - Country:US
Mailing Address - Phone:614-883-8100
Mailing Address - Fax:614-883-8101
Practice Address - Street 1:4138 HOOVER RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-3625
Practice Address - Country:US
Practice Address - Phone:614-883-8100
Practice Address - Fax:614-883-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2093103Medicaid
OHU64253Medicare UPIN
OH4036491Medicare PIN