Provider Demographics
NPI:1689282543
Name:HEIM-BOEDECKER, HEATHER ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ELIZABETH
Last Name:HEIM-BOEDECKER
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 1:483 79TH ST
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-3301
Mailing Address - Country:US
Mailing Address - Phone:716-381-2614
Mailing Address - Fax:
Practice Address - Street 1:295 MAIN ST RM 1095
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-2512
Practice Address - Country:US
Practice Address - Phone:716-513-6349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX013337-01111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty