Provider Demographics
NPI:1134876451
Name:HEARON, NATHANIEL JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:JOHN
Last Name:HEARON
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 1:3314 N COLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4403
Mailing Address - Country:US
Mailing Address - Phone:208-377-9930
Mailing Address - Fax:
Practice Address - Street 1:3314 N COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4403
Practice Address - Country:US
Practice Address - Phone:208-377-9930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-2240111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor