Provider Demographics
NPI:1609087998
Name:STONE-CREDEUR, HEATHER ALEECE (DC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ALEECE
Last Name:STONE-CREDEUR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ALEECE
Other - Last Name:CREDEUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:4155 E JEWELL AVE
Mailing Address - Street 2:STE 1018
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4504
Mailing Address - Country:US
Mailing Address - Phone:303-302-0930
Mailing Address - Fax:303-302-0933
Practice Address - Street 1:4155 E JEWELL AVE
Practice Address - Street 2:STE 1018
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4504
Practice Address - Country:US
Practice Address - Phone:303-302-0930
Practice Address - Fax:303-302-0933
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO502078Medicare PIN
COV00435Medicare UPIN
CO502088Medicare PIN