Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 05005 | IA |
NPI | 1003880253 |
---|---|
Provider Name | Dr. Lawrence E Heffron |
First Address | Centerville, IA 52544-1708 |
Second Address | Centerville, IA 52544-1708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 23/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0213025 | (05) | IA |
T01205 | (02) | IA |