Provider Demographics
NPI:1992784730
Name:ZORN, HEIDI C (DC)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:C
Last Name:ZORN
Suffix:
Gender:F
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 38
Mailing Address - Street 2:
Mailing Address - City:SOUTH EGREMONT
Mailing Address - State:MA
Mailing Address - Zip Code:01258-0038
Mailing Address - Country:US
Mailing Address - Phone:413-528-9654
Mailing Address - Fax:413-528-5441
Practice Address - Street 1:44 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH EGREMONT
Practice Address - State:MA
Practice Address - Zip Code:01258-9706
Practice Address - Country:US
Practice Address - Phone:413-528-9654
Practice Address - Fax:413-528-5441
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1610317Medicaid
MA1610317Medicaid