Kristina Mae Heafner, D.C.
Individual provider Active NPI Chiropractor · Shiloh, IL
NPI 1477092542 · NPPES record last updated Jul 20, 2022
Key facts
- NPI
- 1477092542
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 038013054 (IL)
- Practice address
- 1231 Thouvenot LN Ste 100
Shiloh, IL 62269-7203 - Phone
- (618) 234-8300
- Fax
- (618) 234-8295
- NPI assigned
- Feb 21, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038013054 | IL | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Back on Track Eureka, LLC | Chiropractor | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038013054 | IL | Yes |
Addresses
Primary practice location
1231 Thouvenot LN Ste 100
Shiloh, IL 62269-7203
Mailing address
1231 Thouvenot LN Ste 100
Shiloh, IL 62269-7203
Phone (618) 234-8300
Other providers in Shiloh, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.