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General NPI Number Information
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NPI Number | 1891196721
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Entity Type | Organization
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Legal Business Name | HEIB CHIROPRACTIC INC
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Dates
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Enumeration Date | 09/10/2014
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Last Update Date | 09/10/2014
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Provider Practice Location Address
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Address Line | 2225 E CENTRE AVE
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City | PORTAGE
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State | MI
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Zip | 49002-4421
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Country | US
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Telephone | 269-324-0100
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Fax | 269-324-5295
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Provider Business Mailing Address
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Address Line | 2225 E CENTRE AVE
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City | PORTAGE
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State | MI
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Zip | 49002-4421
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Country | US
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Telephone | 269-324-0100
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Fax | 269-324-5295
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREW J HEIB
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Credential | D.C.
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Telephone | 269-324-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 6816
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License Number State | MI
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