Provider Demographics
NPI:1669444014
Name:HEFFRON, PATRICK S (DC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:S
Last Name:HEFFRON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:PAT
Other - Middle Name:S
Other - Last Name:HEFFRON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:410 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IA
Mailing Address - Zip Code:50060-1530
Mailing Address - Country:US
Mailing Address - Phone:641-872-2435
Mailing Address - Fax:641-872-2438
Practice Address - Street 1:410 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IA
Practice Address - Zip Code:50060-1530
Practice Address - Country:US
Practice Address - Phone:641-872-2435
Practice Address - Fax:641-872-2438
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA063776111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00109484OtherRR MEDICARE NUMBER
IA1226456Medicaid
IA25268OtherBCBS NUMBER
IAI12847Medicare PIN
IA1226456Medicaid