Provider Demographics
NPI:1477885887
Name:HEITKAMP, AMY N (DC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:N
Last Name:HEITKAMP
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:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:MARIA STEIN
Mailing Address - State:OH
Mailing Address - Zip Code:45860-0061
Mailing Address - Country:US
Mailing Address - Phone:937-492-3800
Mailing Address - Fax:
Practice Address - Street 1:1029 FAIR RD
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-8947
Practice Address - Country:US
Practice Address - Phone:937-492-3800
Practice Address - Fax:937-492-3811
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor