Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 4401-12 | WI |
NPI | 1235301490 |
---|---|
Provider Name | David Heitmann |
First Address | Madison, WI 53714-1447 |
Second Address | Madison, WI 53714-1447 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2008 |
Last Update Date | 27/03/2008 |