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NPI Code Detail

MEDICARE: RODERICK M. HEASTY D.C.

MEDICARE:   RODERICK M. HEASTY  D.C.
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
1111N00000XChiropractor01-05525KS

General Provider Information

NPI Number : 1790026409
Entity Type Code : Individual
Provider Name (Legal Business Name) : RODERICK M. HEASTY D.C.
Provider Business Mailing Address
First Line : 3252 KIMBALL AVE
Second Line :
City : MANHATTAN
State : KS
Zip : 66503-2157
Country : US
Telephone Number : 785-320-6868
Fax Number :
Provider Business Practice Location Address
First Line : 3252 KIMBALL AVE
Second Line :
City : MANHATTAN
State : KS
Zip : 66503-2157
Country : US
Telephone Number : 785-320-6868
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2013
Last Update Date : 03/05/2013

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Directions to “ RODERICK M. HEASTY D.C.” Practice Location

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