Provider Demographics
NPI:1619184546
Name:DAVID HEINISH DC PA
Entity Type:Organization
Organization Name:DAVID HEINISH DC PA
Other - Org Name:HEINISH FAMILY CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAIVD
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINISH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-775-1074
Mailing Address - Street 1:1209 SAXON BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8402
Mailing Address - Country:US
Mailing Address - Phone:386-775-1074
Mailing Address - Fax:386-775-1705
Practice Address - Street 1:1209 SAXON BLVD STE 3
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8402
Practice Address - Country:US
Practice Address - Phone:386-775-1074
Practice Address - Fax:386-775-1705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89121OtherCHIROPRACTOR
FL89121ZMedicare ID - Type UnspecifiedCHIROPRACTOR