Provider Demographics
NPI:1396710117
Name:HEITMAN, DANIEL S (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:S
Last Name:HEITMAN
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:PO BOX 739
Mailing Address - Street 2:
Mailing Address - City:STORM LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50588-0739
Mailing Address - Country:US
Mailing Address - Phone:712-732-8527
Mailing Address - Fax:
Practice Address - Street 1:1515 E LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-2677
Practice Address - Country:US
Practice Address - Phone:712-732-8527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06196111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0190983Medicaid
IA0190983Medicaid