1720093164 NPI number — MISS HEIDI HIEGEL SCHLEIFFARTH DPT

Table of content: MISS HEIDI HIEGEL SCHLEIFFARTH DPT (NPI 1720093164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720093164 NPI number — MISS HEIDI HIEGEL SCHLEIFFARTH DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHLEIFFARTH
Provider First Name:
HEIDI
Provider Middle Name:
HIEGEL
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALDRICH
Provider Other First Name:
HEIDI
Provider Other Middle Name:
HIEGEL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720093164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 W WACKER DR
Provider Second Line Business Mailing Address:
SUITE 1020
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60606-1216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-640-0329
Provider Business Mailing Address Fax Number:
312-640-0407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3720 QUEEN CT SW
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
CEDAR RAPIDS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52404-4735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-365-9439
Provider Business Practice Location Address Fax Number:
319-365-9368
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  004042 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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