Provider Demographics
NPI:1568469047
Name:HEFFERN, KIM ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:ALAN
Last Name:HEFFERN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 S PLAZA DR
Mailing Address - Street 2:SUITE 318
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1508
Mailing Address - Country:US
Mailing Address - Phone:651-688-0736
Mailing Address - Fax:
Practice Address - Street 1:750 S PLAZA DR
Practice Address - Street 2:SUITE 318
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120-1508
Practice Address - Country:US
Practice Address - Phone:651-688-0736
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2552111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT39697Medicare UPIN