Provider Demographics
NPI:1841350519
Name:MEINKE, HEATHER A (DC)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:A
Last Name:MEINKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 BASELINE RD
Mailing Address - Street 2:SUITE C-110
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2699
Mailing Address - Country:US
Mailing Address - Phone:303-494-2800
Mailing Address - Fax:303-499-8007
Practice Address - Street 1:4800 BASELINE RD
Practice Address - Street 2:SUITE C-110
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2699
Practice Address - Country:US
Practice Address - Phone:303-494-2800
Practice Address - Fax:303-499-8007
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U89678Medicare UPIN
C808339Medicare PIN