Provider Demographics
NPI:1558430793
Name:HEIKKINEN, PAUL HAROLD (BS, DC, CCSP, FASA)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:HAROLD
Last Name:HEIKKINEN
Suffix:
Gender:M
Credentials:BS, DC, CCSP, FASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 ROSBURY CT
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-3540
Mailing Address - Country:US
Mailing Address - Phone:972-222-3737
Mailing Address - Fax:
Practice Address - Street 1:820 E CARTWRIGHT RD
Practice Address - Street 2:SUITE 133
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-6063
Practice Address - Country:US
Practice Address - Phone:972-285-3232
Practice Address - Fax:972-285-5993
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4245111NS0005X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82K731OtherBCBS PROVIDER NUMBER
TX82K731OtherBCBS PROVIDER NUMBER
TX82K731OtherBCBS PROVIDER NUMBER
TXU06296Medicare UPIN