Provider Demographics
NPI:1114000387
Name:KAUFFMAN, HEATHER RAE (DC)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:RAE
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 CONVERSE AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-5304
Mailing Address - Country:US
Mailing Address - Phone:307-632-5901
Mailing Address - Fax:307-632-4280
Practice Address - Street 1:1600 CONVERSE AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5304
Practice Address - Country:US
Practice Address - Phone:307-632-5901
Practice Address - Fax:307-632-4280
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYU51288Medicare UPIN
W9419Medicare ID - Type Unspecified