Provider Demographics
NPI:1639186745
Name:PENDLETON, HEIDI (DC)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 SHOEMAKER RD
Mailing Address - Street 2:UNIT D
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-6430
Mailing Address - Country:US
Mailing Address - Phone:610-718-1183
Mailing Address - Fax:610-718-5512
Practice Address - Street 1:142 SHOEMAKER RD
Practice Address - Street 2:UNIT D
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-6430
Practice Address - Country:US
Practice Address - Phone:610-718-1183
Practice Address - Fax:610-718-5512
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007198L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU73043Medicare UPIN
PA021376U01Medicare ID - Type UnspecifiedMEDICARE