Provider Demographics
NPI:1841416948
Name:HEYDINGER FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:HEYDINGER FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:HEYDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-668-8412
Mailing Address - Street 1:295 MILAN AVE.
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2513
Mailing Address - Country:US
Mailing Address - Phone:419-668-8412
Mailing Address - Fax:
Practice Address - Street 1:295 MILAN AVE.
Practice Address - Street 2:SUITE 3
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2513
Practice Address - Country:US
Practice Address - Phone:419-668-8412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3726111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HE9369031Medicare PIN