Provider Demographics
NPI:1457082596
Name:HEIKES, THOMAS PARKER (LAC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:PARKER
Last Name:HEIKES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 S WASHINGTON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-3063
Mailing Address - Country:US
Mailing Address - Phone:406-218-6493
Mailing Address - Fax:
Practice Address - Street 1:619 S WASHINGTON ST STE 202
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3063
Practice Address - Country:US
Practice Address - Phone:208-495-5510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDACU-440171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist