Provider Demographics
NPI:1255406989
Name:HEITHAUS, RICHARD JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOSEPH
Last Name:HEITHAUS
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:PO BOX 768
Mailing Address - Street 2:
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-0768
Mailing Address - Country:US
Mailing Address - Phone:724-523-5955
Mailing Address - Fax:724-523-5955
Practice Address - Street 1:711 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-1896
Practice Address - Country:US
Practice Address - Phone:724-523-5995
Practice Address - Fax:724-523-5995
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-002888-L111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA049974Medicaid
PA049974Medicaid
PA049974Medicare PIN