Provider Demographics
NPI:1740432129
Name:HEINZ CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:HEINZ CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:HEINZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-375-1411
Mailing Address - Street 1:1436A PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2134
Mailing Address - Country:US
Mailing Address - Phone:610-375-1411
Mailing Address - Fax:
Practice Address - Street 1:1436A PENN AVE
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2134
Practice Address - Country:US
Practice Address - Phone:610-375-1411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 009691111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty