Provider Demographics
NPI:1861556813
Name:HEITZMAN, DONNA KATHREEN (DC)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:KATHREEN
Last Name:HEITZMAN
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 1:160 KENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13208
Mailing Address - Country:US
Mailing Address - Phone:315-663-1939
Mailing Address - Fax:315-663-1939
Practice Address - Street 1:241 COMMERCIAL ST
Practice Address - Street 2:WHALERS WHARF
Practice Address - City:PROVINCETOWN
Practice Address - State:MA
Practice Address - Zip Code:02657-2102
Practice Address - Country:US
Practice Address - Phone:508-487-3799
Practice Address - Fax:508-487-3799
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3539111N00000X
MA770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35577OtherBCBS OF MA
MAY35577OtherBCBS OF MA
MAY36357Medicare ID - Type UnspecifiedCHIRO