Provider Demographics
NPI:1194982348
Name:DANITA THOMAS HEAGY, D.C., LLC
Entity type:Organization
Organization Name:DANITA THOMAS HEAGY, D.C., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS HEAGY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-797-5100
Mailing Address - Street 1:4425 US HIGHWAY 1 S STE 109
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-3127
Mailing Address - Country:US
Mailing Address - Phone:904-797-5100
Mailing Address - Fax:904-797-5203
Practice Address - Street 1:4425 US HIGHWAY 1 S STE 109
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3127
Practice Address - Country:US
Practice Address - Phone:904-797-5100
Practice Address - Fax:904-797-5203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4199111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88095ZMedicare UPIN