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General NPI Number Information
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NPI Number | 1801991922
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Entity Type | Individual
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Provider Name | JOSEPH PETER HEFFERNAN D.C.
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Gender | Male
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 07/28/2010
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Provider Practice Location Address
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Address Line | 1820 E MAIN ST
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City | WAUKESHA
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State | WI
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Zip | 53186-3902
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Country | US
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Telephone | 262-549-4555
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Fax | 262-549-9750
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Provider Business Mailing Address
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Address Line | N24W30460 CRYSTAL SPRINGS DR
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City | PEWAUKEE
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State | WI
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Zip | 53072-4275
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Country | US
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Telephone | 262-369-9939
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Fax |
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1326
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 1326
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License Number State | WI
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