Provider Demographics
NPI:1922039163
Name:ROLES, HEIDI LYNN (DC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYNN
Last Name:ROLES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:LYNN
Other - Last Name:BARRINGTON-ROLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2636A CHURN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1125
Mailing Address - Country:US
Mailing Address - Phone:530-244-1088
Mailing Address - Fax:530-221-4464
Practice Address - Street 1:2636A CHURN CREEK RD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1125
Practice Address - Country:US
Practice Address - Phone:530-244-1088
Practice Address - Fax:530-221-4464
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19702111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor