Provider Demographics
NPI:1861662983
Name:HEINITZ, GINGER (DC)
Entity Type:Individual
Prefix:DR
First Name:GINGER
Middle Name:
Last Name:HEINITZ
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 1:1178 E DRAPER PKWY
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9095
Mailing Address - Country:US
Mailing Address - Phone:316-617-0376
Mailing Address - Fax:
Practice Address - Street 1:1178 E DRAPER PKWY
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9095
Practice Address - Country:US
Practice Address - Phone:316-617-0376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05187111N00000X
UT8380225-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS062501OtherBLUE CROSS BLUE SHIELD
KS062491OtherBLUE CROSS BLUE SHIELD
KS062491OtherBLUE CROSS BLUE SHIELD
KS062501OtherBLUE CROSS BLUE SHIELD