Provider Demographics
NPI:1346223393
Name:EINCK, HEATHER JO (DC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:JO
Last Name:EINCK
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:PO BOX 178
Mailing Address - Street 2:215 FIRST STREET NE
Mailing Address - City:PRIMGHAR
Mailing Address - State:IA
Mailing Address - Zip Code:51245-0178
Mailing Address - Country:US
Mailing Address - Phone:712-957-0102
Mailing Address - Fax:712-957-0103
Practice Address - Street 1:215 1ST ST NE
Practice Address - Street 2:
Practice Address - City:PRIMGHAR
Practice Address - State:IA
Practice Address - Zip Code:51245-1000
Practice Address - Country:US
Practice Address - Phone:712-957-0102
Practice Address - Fax:712-957-0103
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1280867Medicaid
238563OtherMIDLANDS CHOICE
IAP00379564OtherRAILROAD MEDICARE
IA31576OtherBLUE CROSS BLUE SHIELD
28018OtherSIOUX VALLEY HEALTH PLAN
IAP00379564OtherRAILROAD MEDICARE
IA1280867Medicaid