Provider Demographics
NPI:1417379223
Name:HEATH, ELISSA (DC)
Entity Type:Individual
Prefix:DR
First Name:ELISSA
Middle Name:
Last Name:HEATH
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 1:2751 E. CHAPMAN AVE.
Mailing Address - Street 2:SUITE 109
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3710
Mailing Address - Country:US
Mailing Address - Phone:714-350-1518
Mailing Address - Fax:888-308-9570
Practice Address - Street 1:2751 E. CHAPMAN AVE.
Practice Address - Street 2:SUITE 109
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3710
Practice Address - Country:US
Practice Address - Phone:714-350-1518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor