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General NPI Number Information
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NPI Number | 1740432129
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Entity Type | Organization
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Legal Business Name | HEINZ CHIROPRACTIC LLC
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Dates
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Enumeration Date | 10/16/2008
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Last Update Date | 06/05/2019
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Provider Practice Location Address
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Address Line | 1436A PENN AVE
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City | WYOMISSING
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State | PA
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Zip | 19610-2134
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Country | US
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Telephone | 610-375-1411
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Fax |
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Provider Business Mailing Address
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Address Line | 1436A PENN AVE
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City | WYOMISSING
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State | PA
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Zip | 19610-2134
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Country | US
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Telephone | 610-375-1411
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. JARED BENJAMIN HEINZ
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Credential |
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Telephone | 610-375-1411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC 009691
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License Number State | PA
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