Healthcare Provider Details

I. General information

NPI: 1235257254
Provider Name (Legal Business Name): MICHAEL JOHN HEYER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

011 1ST AVE NE
TITONKA IA
50480-0341
US

IV. Provider business mailing address

PO BOX 341 011 1ST AVE NE
TITONKA IA
50480-0341
US

V. Phone/Fax

Practice location:
  • Phone: 515-928-2567
  • Fax: 515-928-2897
Mailing address:
  • Phone: 515-928-2567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberA05490
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: