Provider Demographics
NPI:1205975042
Name:NORMAN, HEIDI (DC)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:NORMAN
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 1:118 MAINE MALL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2309
Mailing Address - Country:US
Mailing Address - Phone:207-772-1031
Mailing Address - Fax:207-772-1031
Practice Address - Street 1:118 MAINE MALL RD
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2309
Practice Address - Country:US
Practice Address - Phone:207-772-1031
Practice Address - Fax:207-772-1031
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHAA24309Medicare UPIN
NH668741Medicare UPIN
NH7705Y007894NH1Medicare UPIN