Provider Demographics
NPI:1952520512
Name:HEATER, KENNETH W (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:W
Last Name:HEATER
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 460
Mailing Address - Street 2:
Mailing Address - City:WILLCOX
Mailing Address - State:AZ
Mailing Address - Zip Code:85644-0460
Mailing Address - Country:US
Mailing Address - Phone:520-384-2285
Mailing Address - Fax:520-384-2286
Practice Address - Street 1:780 W REX ALLEN DR
Practice Address - Street 2:
Practice Address - City:WILLCOX
Practice Address - State:AZ
Practice Address - Zip Code:85643-1140
Practice Address - Country:US
Practice Address - Phone:520-384-2285
Practice Address - Fax:520-384-2286
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ936111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor