Provider Demographics
NPI:1538455571
Name:HEINRICHS, GORDON D (DC)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:D
Last Name:HEINRICHS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3111 CAMINO DEL RIO N
Mailing Address - Street 2:1000
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5720
Mailing Address - Country:US
Mailing Address - Phone:619-641-6705
Mailing Address - Fax:619-641-7185
Practice Address - Street 1:3111 CAMINO DEL RIO N
Practice Address - Street 2:1000
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-5720
Practice Address - Country:US
Practice Address - Phone:619-641-6705
Practice Address - Fax:619-641-7185
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA14630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor