MEDICARE: HEFFRON CHIROPRACTIC OFFICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	002652	NY

General Provider Information

NPI Number	:	1285013862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEFFRON CHIROPRACTIC OFFICE

Provider Business Mailing Address
First Line	:	8003 211TH ST
Second Line	:
City	:	HOLLIS HILLS
State	:	NY
Zip	:	11427
Country	:	US
Telephone Number	:	718-464-8948
Fax Number	:

Provider Business Practice Location Address
First Line	:	8003 211TH ST
Second Line	:
City	:	HOLLIS HILLS
State	:	NY
Zip	:	11427
Country	:	US
Telephone Number	:	718-464-8948
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK HEFFRON
Credential	:	D.C.
Telephone Number	:	718-464-8948

Provider Enumeration Date	:	05/28/2015
Last Update Date	:	05/28/2015

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