Provider Demographics
NPI:1235140344
Name:D'AMBROSI, HEATHER ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ELIZABETH
Last Name:D'AMBROSI
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 1:279 HOGAN FARM RD
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27523-5442
Mailing Address - Country:US
Mailing Address - Phone:919-389-1910
Mailing Address - Fax:919-303-2501
Practice Address - Street 1:211 S SALEM ST STE C
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-1878
Practice Address - Country:US
Practice Address - Phone:919-303-2500
Practice Address - Fax:919-303-2501
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3428111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
2458017Medicare PIN