Provider Demographics
NPI:1366443582
Name:HEAVNER, RICHARD D (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:HEAVNER
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 1:2234 W PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4047
Mailing Address - Country:US
Mailing Address - Phone:843-665-7817
Mailing Address - Fax:843-665-7447
Practice Address - Street 1:1501 HERITAGE LN
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-3141
Practice Address - Country:US
Practice Address - Phone:843-665-7817
Practice Address - Fax:843-665-7928
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2207Medicaid
SCCH2207Medicaid