Provider Demographics
NPI:1881099158
Name:MCCRACKIN, HEATHER R (DC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:MCCRACKIN
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 1:7432 NW RIVER PARK DR
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-5028
Mailing Address - Country:US
Mailing Address - Phone:816-382-3424
Mailing Address - Fax:
Practice Address - Street 1:7432 NW RIVER PARK DR
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MO
Practice Address - Zip Code:64152-5028
Practice Address - Country:US
Practice Address - Phone:816-382-3424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2015-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014033049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor