Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 5173 | NC |
NPI | 1003443268 |
---|---|
Provider Name | Kathryn Suzanne Heidt |
First Address | Forest City, NC 28043-2874 |
Second Address | Forest City, NC 28043-2874 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2020 |
Last Update Date | 26/03/2020 |