Provider Demographics
NPI:1932131885
Name:HEDDLES, JEFF M (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:M
Last Name:HEDDLES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 S INDIANA AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-4732
Mailing Address - Country:US
Mailing Address - Phone:312-922-9868
Mailing Address - Fax:312-922-9869
Practice Address - Street 1:1600 S INDIANA AVE
Practice Address - Street 2:UNIT B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4732
Practice Address - Country:US
Practice Address - Phone:312-922-9868
Practice Address - Fax:312-922-9869
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009579111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL95403Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID