Provider Demographics
NPI:1578669263
Name:HEINS, JON P (DC)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:P
Last Name:HEINS
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:PO BOX 131
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:NJ
Mailing Address - Zip Code:07823
Mailing Address - Country:US
Mailing Address - Phone:908-475-2933
Mailing Address - Fax:908-475-4225
Practice Address - Street 1:1 BROOKFIELD GLEN DR
Practice Address - Street 2:SUITE B
Practice Address - City:BELVIDERE
Practice Address - State:NJ
Practice Address - Zip Code:07823-2854
Practice Address - Country:US
Practice Address - Phone:908-475-2933
Practice Address - Fax:908-475-4225
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00522400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7793405Medicaid
NJ2146333OtherAETNA
NJ5899539OtherGHI
NJP1223152OtherOXFORD
NJ020974Medicare ID - Type Unspecified
NJ7793405Medicaid