Provider Demographics
NPI:1326262999
Name:HEARTSILL, ROBERT K (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:K
Last Name:HEARTSILL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6032 FRAZIER MTN PARK RD
Mailing Address - Street 2:PO BOX 1765
Mailing Address - City:FRAZIER PARK
Mailing Address - State:CA
Mailing Address - Zip Code:93225
Mailing Address - Country:US
Mailing Address - Phone:661-245-3748
Mailing Address - Fax:
Practice Address - Street 1:6032 FRAZIER MTN PARK RD
Practice Address - Street 2:
Practice Address - City:FRAZIER PARK
Practice Address - State:CA
Practice Address - Zip Code:93225
Practice Address - Country:US
Practice Address - Phone:661-245-3748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21999111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor