Provider Demographics
NPI:1003890773
Name:HELLER, BEA (DC)
Entity Type:Individual
Prefix:DR
First Name:BEA
Middle Name:
Last Name:HELLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:BEATE
Other - Middle Name:
Other - Last Name:HELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 1248
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-1248
Mailing Address - Country:US
Mailing Address - Phone:714-898-0515
Mailing Address - Fax:714-843-0097
Practice Address - Street 1:8840 WARNER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3232
Practice Address - Country:US
Practice Address - Phone:714-898-0515
Practice Address - Fax:714-841-1551
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15815111N00000X
CADC 15815111NS0005X, 111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Not Answered111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT 18154Medicare UPIN