Provider Demographics
NPI:1700055050
Name:GOODSPEED, HEATHER ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ANN
Last Name:GOODSPEED
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 1:200 PROVIDENCE MINE RD
Mailing Address - Street 2:#108
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-2958
Mailing Address - Country:US
Mailing Address - Phone:530-264-6368
Mailing Address - Fax:530-687-8109
Practice Address - Street 1:200 PROVIDENCE MINE RD
Practice Address - Street 2:#108
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2958
Practice Address - Country:US
Practice Address - Phone:530-264-6368
Practice Address - Fax:530-687-8109
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-25237111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor