Provider Demographics
NPI:1376794099
Name:SHOTT, HEATHER (DC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:SHOTT
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 1:180 WALNUT AVE # B
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-3146
Mailing Address - Country:US
Mailing Address - Phone:619-885-8195
Mailing Address - Fax:760-940-0570
Practice Address - Street 1:902 SYCAMORE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-7879
Practice Address - Country:US
Practice Address - Phone:760-940-0500
Practice Address - Fax:760-940-0570
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31025111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC31025OtherDC LIC NUMBER