Provider Demographics
NPI:1508272857
Name:HECKMAN, JASON R
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:HECKMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 POE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-3440
Mailing Address - Country:US
Mailing Address - Phone:937-458-0322
Mailing Address - Fax:937-401-1021
Practice Address - Street 1:5600 POE AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-3440
Practice Address - Country:US
Practice Address - Phone:937-458-0322
Practice Address - Fax:937-401-1021
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH29800060171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor