Provider Demographics
NPI:1417338757
Name:DAVIDSON, HEATHER NAOMI (DC)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:NAOMI
Last Name:DAVIDSON
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 1:851 LAKE CAROLYN PKWY APT 546
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-4120
Mailing Address - Country:US
Mailing Address - Phone:337-412-0520
Mailing Address - Fax:
Practice Address - Street 1:7992 MAURICE AVE
Practice Address - Street 2:
Practice Address - City:MAURICE
Practice Address - State:LA
Practice Address - Zip Code:70555
Practice Address - Country:US
Practice Address - Phone:337-898-0522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1838111N00000X
TX12894111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor