Provider Demographics
NPI:1407985450
Name:HEIDARY, PEYMAN (DC, PHD)
Entity Type:Individual
Prefix:DR
First Name:PEYMAN
Middle Name:
Last Name:HEIDARY
Suffix:
Gender:M
Credentials:DC, PHD
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 5265
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92838-0265
Mailing Address - Country:US
Mailing Address - Phone:866-255-4362
Mailing Address - Fax:
Practice Address - Street 1:913 N MARKET ST STE 200
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801
Practice Address - Country:US
Practice Address - Phone:866-255-4362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-25035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor