Provider Demographics
NPI:1144357088
Name:HECKERT, SHARON L (DC)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:L
Last Name:HECKERT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 CAPITOLA AVE
Mailing Address - Street 2:SUITE E-1
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2777
Mailing Address - Country:US
Mailing Address - Phone:831-462-9484
Mailing Address - Fax:831-462-9495
Practice Address - Street 1:716 CAPITOLA AVE
Practice Address - Street 2:SUITE E-1
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2777
Practice Address - Country:US
Practice Address - Phone:831-462-9484
Practice Address - Fax:831-462-9495
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0143900Medicare PIN