Provider Demographics
NPI:1376649145
Name:DUCKETT, HEATHER L (DC)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:L
Last Name:DUCKETT
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 1:1601 UNION AVE STE C
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-2133
Mailing Address - Country:US
Mailing Address - Phone:404-414-6794
Mailing Address - Fax:
Practice Address - Street 1:1601 UNION AVE STE C
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2133
Practice Address - Country:US
Practice Address - Phone:404-414-6794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA090003OtherBLUE CROSS/BLUE SHIELD GA
GA35ZCHQXMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER ID
GAGRP6458Medicare ID - Type UnspecifiedGROUP PROVIDER ID