Provider Demographics
NPI:1568755726
Name:LEAM, HEATHER WEST (DC)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:WEST
Last Name:LEAM
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 1:812 W LODI AVE
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-3302
Mailing Address - Country:US
Mailing Address - Phone:209-367-8537
Mailing Address - Fax:209-368-1583
Practice Address - Street 1:812 W LODI AVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3302
Practice Address - Country:US
Practice Address - Phone:209-367-8537
Practice Address - Fax:209-368-1583
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20032111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor