Provider Demographics
NPI:1427193051
Name:HEACOX, ANNETTE BARTOSH (DC)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:BARTOSH
Last Name:HEACOX
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:ANNETTE
Other - Middle Name:BARTOSH
Other - Last Name:HEACOX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:15 11TH AVE W # 829
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:ND
Mailing Address - Zip Code:58054-4306
Mailing Address - Country:US
Mailing Address - Phone:701-680-2031
Mailing Address - Fax:701-683-4943
Practice Address - Street 1:15 11TH AVE W # 829
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:ND
Practice Address - Zip Code:58054-4306
Practice Address - Country:US
Practice Address - Phone:701-680-2031
Practice Address - Fax:701-683-4943
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND533111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor