Healthcare Provider Details

I. General information

NPI: 1720120868
Provider Name (Legal Business Name): HEFFERNAN CHIROPRACTIC CLINIC SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E MAIN ST STE 300
WAUKESHA WI
53186-3984
US

IV. Provider business mailing address

1800 E MAIN ST STE 300
WAUKESHA WI
53186-3984
US

V. Phone/Fax

Practice location:
  • Phone: 262-549-4555
  • Fax: 262-549-9750
Mailing address:
  • Phone: 262-549-4555
  • Fax: 262-549-9750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3874-012
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1326-012
License Number StateWI

VIII. Authorized Official

Name: JOSEPH PETER HEFFERNAN
Title or Position: PRESIDENT
Credential:
Phone: 262-549-4555