Provider Demographics
NPI:1639702459
Name:TAPP, HEATHER NOELLE (DC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:NOELLE
Last Name:TAPP
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:WISSBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1501 ALEXANDRIA PIKE STE 106
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-2561
Mailing Address - Country:US
Mailing Address - Phone:608-617-7598
Mailing Address - Fax:608-617-7598
Practice Address - Street 1:1501 ALEXANDRIA PIKE STE 106
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-2561
Practice Address - Country:US
Practice Address - Phone:608-617-7598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY262008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor