=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861798035
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVE CHARLES HEINRICH D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2011
-----------------------------------------------------
Last Update Date | 07/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5600 W DARTMOUTH AVE #104
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80227-5546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-985-5557
-----------------------------------------------------
Fax | 303-985-2444
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6420 ASHBURN LN
-----------------------------------------------------
City | HIGHLANDS RANCH
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80130-4185
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-358-9734
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 6519
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------