Healthcare Provider Details

I. General information

NPI: 1598165862
Provider Name (Legal Business Name): HEFFERNAN ENTERPRISES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2014
Last Update Date: 08/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14050 PILOT KNOB RD
APPLE VALLEY MN
55124-6647
US

IV. Provider business mailing address

14050 PILOT KNOB RD
APPLE VALLEY MN
55124-6647
US

V. Phone/Fax

Practice location:
  • Phone: 952-423-5050
  • Fax: 952-423-4650
Mailing address:
  • Phone: 952-423-5050
  • Fax: 952-423-4650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number5970
License Number StateMN

VIII. Authorized Official

Name: DR. KYLE MARTIN HEFFERNAN
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 515-293-0026