Provider Demographics
NPI:1336160332
Name:HAFFENER, HEATH (DC)
Entity type:Individual
Prefix:DR
First Name:HEATH
Middle Name:
Last Name:HAFFENER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 W 4TH ST
Mailing Address - Street 2:BLDG B, STE #1
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-3010
Mailing Address - Country:US
Mailing Address - Phone:620-251-1515
Mailing Address - Fax:620-251-1919
Practice Address - Street 1:1901 W 4TH ST
Practice Address - Street 2:BLDG B, STE #1
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-3010
Practice Address - Country:US
Practice Address - Phone:620-251-1515
Practice Address - Fax:620-251-1919
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04632111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU78860Medicare UPIN
KS060375Medicare ID - Type Unspecified