Provider Demographics
NPI:1821158718
Name:BRENT A HEYN, D.C. & WINDY D. HEYN, D.C., PTRS.
Entity Type:Organization
Organization Name:BRENT A HEYN, D.C. & WINDY D. HEYN, D.C., PTRS.
Other - Org Name:LIGHTHOUSE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WINDY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:HEYN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:802-372-5800
Mailing Address - Street 1:8 FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH HERO
Mailing Address - State:VT
Mailing Address - Zip Code:05486-4400
Mailing Address - Country:US
Mailing Address - Phone:802-372-5800
Mailing Address - Fax:802-372-5800
Practice Address - Street 1:8 FERRY RD
Practice Address - Street 2:
Practice Address - City:SOUTH HERO
Practice Address - State:VT
Practice Address - Zip Code:05486-4400
Practice Address - Country:US
Practice Address - Phone:802-372-5800
Practice Address - Fax:802-372-5800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010946Medicaid
VTLIGH00068299OtherBLUECROSS BLUESHIELD
VT1010946Medicaid