Healthcare Provider Details

I. General information

NPI: 1447310917
Provider Name (Legal Business Name): NATHAN WILLIAM HEIMGARTNER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2508 BREEZY POINT LN
O FALLON MO
63368-3510
US

IV. Provider business mailing address

2508 BREEZY POINT LN
O FALLON MO
63368-3510
US

V. Phone/Fax

Practice location:
  • Phone: 314-607-8088
  • Fax: 636-272-7973
Mailing address:
  • Phone: 314-607-8088
  • Fax: 636-272-7973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2006000760
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: