Provider Demographics
NPI:1598165862
Name:HEFFERNAN ENTERPRISES PLLC
Entity Type:Organization
Organization Name:HEFFERNAN ENTERPRISES PLLC
Other - Org Name:EAST VALLEY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:HEFFERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-293-0026
Mailing Address - Street 1:14050 PILOT KNOB RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-6647
Mailing Address - Country:US
Mailing Address - Phone:952-423-5050
Mailing Address - Fax:952-423-4650
Practice Address - Street 1:14050 PILOT KNOB RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-6647
Practice Address - Country:US
Practice Address - Phone:952-423-5050
Practice Address - Fax:952-423-4650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-24
Last Update Date:2014-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5970261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center