Healthcare Provider Details

I. General information

NPI: 1003929951
Provider Name (Legal Business Name): AMY LYNN HEGGEMANN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 MAIN PLAZA DRIVE
WENTZVILLE MO
63385-1170
US

IV. Provider business mailing address

18446 SELLENSCHUTTER HOLLOW RD.
MARTHASVILLE MO
63357-2923
US

V. Phone/Fax

Practice location:
  • Phone: 636-639-8944
  • Fax: 636-639-8922
Mailing address:
  • Phone: 636-932-4003
  • Fax: 636-932-4003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number2006023222
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: