Provider Demographics
NPI:1467876227
Name:HEINTZE, ELDA (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:ELDA
Middle Name:
Last Name:HEINTZE
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18484 47TH PL NE
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-4354
Mailing Address - Country:US
Mailing Address - Phone:425-686-4498
Mailing Address - Fax:425-368-5245
Practice Address - Street 1:18223 102ND AVE NE STE A
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3454
Practice Address - Country:US
Practice Address - Phone:425-686-4498
Practice Address - Fax:425-368-5245
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60414966171100000X
WANT60414858175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath