Provider Demographics
NPI:1154405504
Name:HEIDEN CHIROPRACTIC INC.
Entity type:Organization
Organization Name:HEIDEN CHIROPRACTIC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEIDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-534-6090
Mailing Address - Street 1:11378 CHASE ST
Mailing Address - Street 2:
Mailing Address - City:TREMPEALEAU
Mailing Address - State:WI
Mailing Address - Zip Code:54661-9240
Mailing Address - Country:US
Mailing Address - Phone:608-534-6090
Mailing Address - Fax:
Practice Address - Street 1:11378 CHASE ST
Practice Address - Street 2:
Practice Address - City:TREMPEALEAU
Practice Address - State:WI
Practice Address - Zip Code:54661-9240
Practice Address - Country:US
Practice Address - Phone:608-534-6090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4249-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4249-012OtherWI LICENSE
WI1700986411OtherINDIVIDUAL NPI NUMBER