Provider Demographics
NPI:1912545575
Name:HECKARD, DEJA ELISE
Entity Type:Individual
Prefix:
First Name:DEJA
Middle Name:ELISE
Last Name:HECKARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 S PARKER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-2178
Mailing Address - Country:US
Mailing Address - Phone:720-575-4457
Mailing Address - Fax:
Practice Address - Street 1:1250 S PARKER RD STE 103
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-2178
Practice Address - Country:US
Practice Address - Phone:720-575-4457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CON.0000197175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath