Provider Demographics
NPI:1518015940
Name:HEACOCK, NANCY ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ANN
Last Name:HEACOCK
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 1:1613 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1925
Mailing Address - Country:US
Mailing Address - Phone:269-345-3660
Mailing Address - Fax:
Practice Address - Street 1:1613 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1925
Practice Address - Country:US
Practice Address - Phone:269-345-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C95039Medicare ID - Type Unspecified