Provider Demographics
NPI:1710038807
Name:REED, HEATHER C (DC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:C
Last Name:REED
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 1:11030 N TATUM BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6073
Mailing Address - Country:US
Mailing Address - Phone:602-787-9600
Mailing Address - Fax:
Practice Address - Street 1:11030 N TATUM BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6073
Practice Address - Country:US
Practice Address - Phone:602-787-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7441111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ705727Medicare ID - Type UnspecifiedPROVIDER NUMBER