Provider Demographics
NPI:1700941036
Name:HEINRICH, KIMBERLY MAULDIN (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:MAULDIN
Last Name:HEINRICH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:J
Other - Last Name:HEINRICH
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:4131 SPICEWOOD SPRINGS RD.
Mailing Address - Street 2:#O-1
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8661
Mailing Address - Country:US
Mailing Address - Phone:512-795-0707
Mailing Address - Fax:512-795-7742
Practice Address - Street 1:4131 SPICEWOOD SPRINGS RD.
Practice Address - Street 2:#O-1
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8661
Practice Address - Country:US
Practice Address - Phone:512-795-0707
Practice Address - Fax:512-795-7742
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5085111N00000X
TXDC5085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
8M2021OtherBCBS
TXHUMANA ID#1219339OtherHUMANA HEALTHCARE
#8M2021OtherBCBS
TXBCBS 8M2021OtherBCBS
TXBCBS 8M2021OtherBCBS
600138Medicare PIN
#8M2021OtherBCBS
8M2021OtherBCBS