Healthcare Provider Details

I. General information

NPI: 1861292989
Provider Name (Legal Business Name): KOLTON M HEENAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 S ISABELLA RD
MOUNT PLEASANT MI
48858-7398
US

IV. Provider business mailing address

1820 S CRAWFORD ST APT F11
MOUNT PLEASANT MI
48858-6149
US

V. Phone/Fax

Practice location:
  • Phone: 989-773-1816
  • Fax:
Mailing address:
  • Phone: 920-358-4885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301401614
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: