Provider Demographics
NPI:1679268924
Name:HEIDENREICH, HANNAH L (DC)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:L
Last Name:HEIDENREICH
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 1:14637 FERN LAKE CT
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34114-8671
Mailing Address - Country:US
Mailing Address - Phone:239-595-1453
Mailing Address - Fax:
Practice Address - Street 1:4280 TAMIAMI TRL E STE 102
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-6705
Practice Address - Country:US
Practice Address - Phone:239-774-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14481111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor