Provider Demographics
NPI:1700085057
Name:WA HEFFRON III CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:WA HEFFRON III CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HEFFRON
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:660-947-3518
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63565-0207
Mailing Address - Country:US
Mailing Address - Phone:660-947-3518
Mailing Address - Fax:660-947-0099
Practice Address - Street 1:2808 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:MO
Practice Address - Zip Code:63565
Practice Address - Country:US
Practice Address - Phone:660-947-3518
Practice Address - Fax:660-947-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999134929111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO365235OtherHUMANA
MO131606OtherBLUE CROSS BLUE SHIELD
MO428018OtherHEALTHLINK
MO131606OtherBLUE CROSS BLUE SHIELD