MEDICARE: JUSTIN HEIDEMANN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	13719382-1202	UT

General Provider Information

NPI Number	:	1649031089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN HEIDEMANN DC

Provider Business Mailing Address
First Line	:	2605 E 3300 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-2728
Country	:	US
Telephone Number	:	801-855-6959
Fax Number	:

Provider Business Practice Location Address
First Line	:	2605 E 3300 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-2728
Country	:	US
Telephone Number	:	801-855-6959
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2024
Last Update Date	:	07/23/2024

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Directions to “ JUSTIN HEIDEMANN DC” Practice Location

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