Provider Demographics
NPI:1275757965
Name:SERPA, HEATHER M (DC)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:M
Last Name:SERPA
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 1:513 NATOMA ST
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-2523
Mailing Address - Country:US
Mailing Address - Phone:916-984-1939
Mailing Address - Fax:916-984-1939
Practice Address - Street 1:513 NATOMA ST
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-2523
Practice Address - Country:US
Practice Address - Phone:916-984-1939
Practice Address - Fax:916-984-1939
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25379111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU70972Medicare UPIN
CADC0253790Medicare ID - Type Unspecified