Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 7656 | AZ |
N | 111NS0005X | Chiropractic Sports Physician | 7656 | AZ |
NPI | 1023225711 |
---|---|
Provider Name | Dr. Gerard Hefferon |
First Address | Gilbert, AZ 85234-2425 |
Second Address | Gilbert, AZ 85234-2425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 08/07/2007 |