Provider Demographics
NPI:1578984894
Name:HEATHERMAN, JAMES MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:HEATHERMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:MICHAEL
Other - Last Name:HEATHERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14876 METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2206
Mailing Address - Country:US
Mailing Address - Phone:913-808-5245
Mailing Address - Fax:913-808-5244
Practice Address - Street 1:14876 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2206
Practice Address - Country:US
Practice Address - Phone:913-808-5245
Practice Address - Fax:913-808-5244
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor