Healthcare Provider Details

I. General information

NPI: 1285013862
Provider Name (Legal Business Name): HEFFRON CHIROPRACTIC OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8003 211TH ST
HOLLIS HILLS NY
11427
US

IV. Provider business mailing address

8003 211TH ST
HOLLIS HILLS NY
11427
US

V. Phone/Fax

Practice location:
  • Phone: 718-464-8948
  • Fax:
Mailing address:
  • Phone: 718-464-8948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number002652
License Number StateNY

VIII. Authorized Official

Name: DR. MARK HEFFRON
Title or Position: OWNER
Credential: D.C.
Phone: 718-464-8948