Provider Demographics
NPI:1386703288
Name:HEIMLICH, MYRON SIMON (DC)
Entity type:Individual
Prefix:
First Name:MYRON
Middle Name:SIMON
Last Name:HEIMLICH
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 1:16627 SEA LARK RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-5818
Mailing Address - Country:US
Mailing Address - Phone:281-486-1947
Mailing Address - Fax:281-486-7306
Practice Address - Street 1:16627 SEA LARK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-5818
Practice Address - Country:US
Practice Address - Phone:281-486-1947
Practice Address - Fax:281-486-7306
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor