Provider Demographics
NPI:1427075167
Name:HEEREN, PAUL E (DC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:E
Last Name:HEEREN
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 1:2514 BOSTON POST RD
Mailing Address - Street 2:STE 7C
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437
Mailing Address - Country:US
Mailing Address - Phone:203-453-9888
Mailing Address - Fax:203-453-0517
Practice Address - Street 1:2514 BOSTON POST RD
Practice Address - Street 2:STE 7C
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437
Practice Address - Country:US
Practice Address - Phone:203-453-9888
Practice Address - Fax:203-453-0517
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000401111N00000X
NJ38MC00244100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
P412768OtherOXFORD
3384OtherHEALTHNET PHS
050000401CT01OtherANTHEM BL CROSS
T226000Medicare UPIN