Provider Demographics
NPI:1801991922
Name:HEFFERNAN, JOSEPH PETER (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PETER
Last Name:HEFFERNAN
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:N24W30460 CRYSTAL SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-4275
Mailing Address - Country:US
Mailing Address - Phone:262-369-9939
Mailing Address - Fax:
Practice Address - Street 1:1820 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-3902
Practice Address - Country:US
Practice Address - Phone:262-549-4555
Practice Address - Fax:262-549-9750
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1326111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391628775OtherTAX I. D. NUMBER
WI391628775OtherTAX I. D. NUMBER