Provider Demographics
NPI:1588798482
Name:MICHELSON, HEATHER JILL (DC)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:JILL
Last Name:MICHELSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:JILL
Other - Last Name:MICHELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1 KIPLING CT
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-2149
Mailing Address - Country:US
Mailing Address - Phone:732-308-3805
Mailing Address - Fax:
Practice Address - Street 1:94 BRIDGE PLAZA DR
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-1700
Practice Address - Country:US
Practice Address - Phone:732-972-5900
Practice Address - Fax:732-972-3232
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00600900111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation