Individual
MONTY CARL HEISNER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
5649 BENTON ROAD, PADUCAH, KY 42003
(270) 898-3052
(270) 898-3052
Mailing address
5649 BENTON ROAD, PADUCAH, KY 42003
(270) 898-3052
(270) 898-3052
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3493R
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000047805
ANTHEM
KY
05
—
85002046
—
KY
Enumeration date
02/22/2006
Last updated
07/08/2007
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