Provider Demographics
NPI:1609019058
Name:WROEBEL, HEIDI JEAN DUDLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:JEAN DUDLEY
Last Name:WROEBEL
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 1:1 RIO VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5320
Mailing Address - Country:US
Mailing Address - Phone:510-654-2399
Mailing Address - Fax:510-654-2376
Practice Address - Street 1:1 RIO VISTA AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5320
Practice Address - Country:US
Practice Address - Phone:510-654-2399
Practice Address - Fax:510-654-2376
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 29842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor