Provider Demographics
NPI:1710277199
Name:HEATH, CARL (DC)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:HEATH
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:P.O. BOX 677449
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267
Mailing Address - Country:US
Mailing Address - Phone:630-754-8788
Mailing Address - Fax:
Practice Address - Street 1:5509 COLLEYVILLE BLVD
Practice Address - Street 2:STE 100
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-7807
Practice Address - Country:US
Practice Address - Phone:817-479-0055
Practice Address - Fax:817-479-0058
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor