Provider Demographics
NPI:1356650576
Name:HEILSBERG, NICOLE KRISTINE (LMP, DC)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:KRISTINE
Last Name:HEILSBERG
Suffix:
Gender:F
Credentials:LMP, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 N SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:WA
Mailing Address - Zip Code:99111-1994
Mailing Address - Country:US
Mailing Address - Phone:509-397-2602
Mailing Address - Fax:
Practice Address - Street 1:1035 NW NYE ST
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-3428
Practice Address - Country:US
Practice Address - Phone:509-334-1241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022917247200000X
WACH 60540639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other