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General NPI Number Information
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NPI Number | 1255406989
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Entity Type | Individual
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Provider Name | RICHARD JOSEPH HEITHAUS D.C.
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Gender | Male
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 08/27/2014
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Provider Practice Location Address
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Address Line | 711 HARRISON AVE
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City | JEANNETTE
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State | PA
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Zip | 15644-1896
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Country | US
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Telephone | 724-523-5995
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Fax | 724-523-5995
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Provider Business Mailing Address
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Address Line | PO BOX 768
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City | JEANNETTE
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State | PA
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Zip | 15644-0768
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Country | US
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Telephone | 724-523-5955
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Fax | 724-523-5955
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | DC-002888-L
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License Number State | PA
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