Provider Demographics
NPI:1588756720
Name:HEYN, BRENT A (DC)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:A
Last Name:HEYN
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 1:8 FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH HERO
Mailing Address - State:VT
Mailing Address - Zip Code:05486-4400
Mailing Address - Country:US
Mailing Address - Phone:802-372-5800
Mailing Address - Fax:802-372-5800
Practice Address - Street 1:8 FERRY RD
Practice Address - Street 2:
Practice Address - City:SOUTH HERO
Practice Address - State:VT
Practice Address - Zip Code:05486-4400
Practice Address - Country:US
Practice Address - Phone:802-372-5800
Practice Address - Fax:802-372-5800
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0001144111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010960Medicaid
VT2300046OtherCIGNA ID#
VT68301OtherBC/BS ID#
VT3742093OtherAETNA ID#
VT2300046OtherCIGNA ID#