Provider Demographics
NPI:1629398037
Name:WHEELER, HEATHER MICHELLE (LAC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MICHELLE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 WILLIAMSTOWN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-8109
Mailing Address - Country:US
Mailing Address - Phone:618-580-4955
Mailing Address - Fax:
Practice Address - Street 1:111 OFALLON COMMONS DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7931
Practice Address - Country:US
Practice Address - Phone:636-978-0970
Practice Address - Fax:636-978-7570
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010008294171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist