Provider Demographics
NPI:1780748707
Name:JAMES J HEATH DC PC
Entity type:Organization
Organization Name:JAMES J HEATH DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-538-1780
Mailing Address - Street 1:403 44TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49548-4327
Mailing Address - Country:US
Mailing Address - Phone:616-538-1780
Mailing Address - Fax:616-538-7941
Practice Address - Street 1:403 44TH ST SE
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49548-4327
Practice Address - Country:US
Practice Address - Phone:616-538-1780
Practice Address - Fax:616-538-7941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007769111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4370387Medicaid
MI0D1514OtherBCN
MI4370387Medicaid
MI0N43100Medicare ID - Type Unspecified