Provider Demographics
NPI:1568786523
Name:CARMONA, HEATHER LYN (DC)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:LYN
Last Name:CARMONA
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 1:5432E PEABODY ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-2544
Mailing Address - Country:US
Mailing Address - Phone:562-371-5216
Mailing Address - Fax:
Practice Address - Street 1:4200 TRABUCO RD
Practice Address - Street 2:SUITE 180
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-3659
Practice Address - Country:US
Practice Address - Phone:949-552-1172
Practice Address - Fax:562-552-8172
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31574111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor