Provider Demographics
NPI:1790259158
Name:HEISSE, RAQUEL (DC)
Entity Type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:
Last Name:HEISSE
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 1:1997 WATERFRONT DR N APT E
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-8953
Mailing Address - Country:US
Mailing Address - Phone:636-439-0147
Mailing Address - Fax:
Practice Address - Street 1:1997 WATERFRONT DR N APT E
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-8953
Practice Address - Country:US
Practice Address - Phone:636-439-0147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019001369111N00000X
MO2019001368111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor