Individual
BOB PHILLIP HEATON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1320 S AMMON ROAD, IDAHO FALLS, ID 83406-5810
(208) 529-2084
(208) 529-2084
Mailing address
1320 S. AMMON ROAD, IDAHO FALLS, ID 83406-5810
(208) 529-2084
(208) 529-2084
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA 369
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010008077
BLUE CROSS BLUE SHIELD
—
05
—
000953900
—
ID
Enumeration date
02/15/2006
Last updated
01/24/2014
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