Provider Demographics
NPI:1902967359
Name:HEFFERNAN, AMY LYNNE
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNNE
Last Name:HEFFERNAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 E MAIN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-3984
Mailing Address - Country:US
Mailing Address - Phone:262-549-4555
Mailing Address - Fax:262-549-9750
Practice Address - Street 1:1800 E MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-3984
Practice Address - Country:US
Practice Address - Phone:262-549-4555
Practice Address - Fax:262-549-9750
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor