Provider Demographics
NPI:1801037411
Name:HEIMER, BRADLEY A (DC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:A
Last Name:HEIMER
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 269031
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-9031
Mailing Address - Country:US
Mailing Address - Phone:580-436-7173
Mailing Address - Fax:580-436-7176
Practice Address - Street 1:1201 ARLINGTON ST STE A
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4072
Practice Address - Country:US
Practice Address - Phone:580-436-7173
Practice Address - Fax:580-436-7176
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11137111N00000X
OK4081111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor