Provider Demographics
NPI:1437762259
Name:HEON, KAITLIN NICOLE (DC)
Entity Type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:NICOLE
Last Name:HEON
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 1:257 TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:HARRAH
Mailing Address - State:OK
Mailing Address - Zip Code:73045-9002
Mailing Address - Country:US
Mailing Address - Phone:405-434-9938
Mailing Address - Fax:
Practice Address - Street 1:2100 HARPER ST
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-8055
Practice Address - Country:US
Practice Address - Phone:405-281-6304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4376111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor