Bob Phillip Heaton, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CHIA 369 Issued in ID

Practice address

1320 S Ammon Road
Idaho Falls, ID 83406-5810

Phone

(208) 529-2084

Fax

(208) 529-2084

NPI assigned

Feb 15, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• East Ridge Chiropractic

  • Chiropractor
  • Ammon, ID
  • NPI 1780290981
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390521600000",
    "number": "1083688030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 S. AMMON ROAD",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834065810",
            "telephone_number": "208-529-2084",
            "fax_number": "208-529-2084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 S AMMON ROAD",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834065810",
            "telephone_number": "208-529-2084",
            "fax_number": "208-529-2084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEATON",
        "first_name": "BOB",
        "middle_name": "PHILLIP",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-15",
        "last_updated": "2014-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "CHIA 369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000953900",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000010008077",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Healing Sanctuary LLC
• Health & Wellness Center of Idaho PLLC
• Healthy Function LLC
• Healthy Place Counseling, Inc.
• Karl W Hearne, RPH
• Don H Heaton, D.C.
• Tyler Hedin, M.D.
• Sierra Dawn Heffron
• Justin Thomas Heintz, OD
• Helix Medical LLC

• Chiropractor in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Chiropractor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.