Provider Demographics
NPI:1366587693
Name:HEFFERON, THOMAS JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:HEFFERON
Suffix:
Gender:M
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:PO BOX 2427
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92082-2427
Mailing Address - Country:US
Mailing Address - Phone:760-749-6680
Mailing Address - Fax:
Practice Address - Street 1:2335 E VALLEY PKWY
Practice Address - Street 2:SUITE H
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-2773
Practice Address - Country:US
Practice Address - Phone:760-741-2828
Practice Address - Fax:760-741-2831
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15094111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC15094Medicare ID - Type Unspecified