=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720120868
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEFFERNAN CHIROPRACTIC CLINIC SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 04/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1800 E MAIN ST STE 300
-----------------------------------------------------
City | WAUKESHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53186-3984
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-549-4555
-----------------------------------------------------
Fax | 262-549-9750
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1800 E MAIN ST STE 300
-----------------------------------------------------
City | WAUKESHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53186-3984
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-549-4555
-----------------------------------------------------
Fax | 262-549-9750
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOSEPH PETER HEFFERNAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 262-549-4555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3874-012
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1326-012
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------