Provider Demographics
NPI:1164532636
Name:HEERMANCE, ANDREA LYN (DC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYN
Last Name:HEERMANCE
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 1:4128 W COMMONWEALTH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-2565
Mailing Address - Country:US
Mailing Address - Phone:714-525-0300
Mailing Address - Fax:714-525-3536
Practice Address - Street 1:4128 W COMMONWEALTH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-2565
Practice Address - Country:US
Practice Address - Phone:714-525-0300
Practice Address - Fax:714-525-3536
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29397111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV01998Medicare UPIN
CADC29397Medicare PIN