Provider Demographics
NPI:1952454258
Name:KLINE, HEIDI (DC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:KLINE
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 1:14390 CLAY TERRACE BLVD
Mailing Address - Street 2:STE 261
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3627
Mailing Address - Country:US
Mailing Address - Phone:317-587-2705
Mailing Address - Fax:
Practice Address - Street 1:14390 CLAY TERRACE BLVD
Practice Address - Street 2:STE 261
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3627
Practice Address - Country:US
Practice Address - Phone:317-587-2705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002315A111N00000X
NC4204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2123Medicare PIN