Provider Demographics
NPI:1710257506
Name:FIEDLER, JARED HEATH (DC)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:HEATH
Last Name:FIEDLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 FISHERMANS RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-4037
Mailing Address - Country:US
Mailing Address - Phone:610-996-3433
Mailing Address - Fax:
Practice Address - Street 1:1920 CENTERVILLE TPKE
Practice Address - Street 2:SUITE 95
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-6800
Practice Address - Country:US
Practice Address - Phone:610-996-3433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010602111N00000X
VA0104557100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor