Provider Demographics
NPI:1942266358
Name:BLACKFORD-HEINTZ, JOAN L (DC)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:L
Last Name:BLACKFORD-HEINTZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:L
Other - Last Name:BLACKFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:5314 26TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-3011
Mailing Address - Country:US
Mailing Address - Phone:941-751-1147
Mailing Address - Fax:941-751-6952
Practice Address - Street 1:5314 26TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-3011
Practice Address - Country:US
Practice Address - Phone:941-751-1147
Practice Address - Fax:941-751-6952
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5959111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U25199Medicare UPIN
FL22418Medicare ID - Type Unspecified