Provider Demographics
NPI:1376748848
Name:HELLER, PAUL M (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:HELLER
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:PO BOX 5392
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92838-0392
Mailing Address - Country:US
Mailing Address - Phone:714-305-4639
Mailing Address - Fax:
Practice Address - Street 1:330 N BREA BLVD
Practice Address - Street 2:SUITE K
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-4054
Practice Address - Country:US
Practice Address - Phone:714-305-4639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19827111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC19827AMedicare ID - Type Unspecified