Provider Demographics
NPI:1740208347
Name:GOLDBERG, HEATHER NICOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:NICOLE
Last Name:GOLDBERG
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 1:1982 BUTLER PIKE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-3701
Mailing Address - Country:US
Mailing Address - Phone:610-940-6756
Mailing Address - Fax:610-940-6797
Practice Address - Street 1:1982 BUTLER PIKE
Practice Address - Street 2:SUITE #2
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-3701
Practice Address - Country:US
Practice Address - Phone:610-940-6756
Practice Address - Fax:610-940-6797
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV08852Medicare UPIN
PA115852W2YMedicare PIN
GA35ZCJNRMedicare ID - Type Unspecified