Provider Demographics
NPI:1609897370
Name:HEAVIN, JEFFREY KENT (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KENT
Last Name:HEAVIN
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 1:130 E EPLER AVE STE C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-1987
Mailing Address - Country:US
Mailing Address - Phone:317-757-5016
Mailing Address - Fax:317-757-5276
Practice Address - Street 1:130 E EPLER AVE STE C
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1987
Practice Address - Country:US
Practice Address - Phone:317-757-5016
Practice Address - Fax:317-757-5276
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000760A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100140490Medicaid
IN2119001Medicare PIN
T34724Medicare UPIN