Provider Demographics
NPI:1669479952
Name:HEFFER, DAVID LANCE (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LANCE
Last Name:HEFFER
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 1:527 E RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-1203
Mailing Address - Country:US
Mailing Address - Phone:585-467-2225
Mailing Address - Fax:585-544-8029
Practice Address - Street 1:527 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-1203
Practice Address - Country:US
Practice Address - Phone:585-467-2225
Practice Address - Fax:585-544-8029
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0005483280OtherAETNA
NY103788ANOtherPREFERRED CARE
NYP010007366OtherEXCELLUS BLUE CROSS BLUE
NYP010007366OtherEXCELLUS BLUE CROSS BLUE
NY11784BMedicare ID - Type UnspecifiedMEDICARE