Provider Demographics
NPI:1396885398
Name:HECIMOVICH, ERIC TONY (DC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:TONY
Last Name:HECIMOVICH
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 1:2800 LONE TREE WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-4922
Mailing Address - Country:US
Mailing Address - Phone:925-754-6868
Mailing Address - Fax:925-754-5016
Practice Address - Street 1:21157 STATE ROUTE 410 E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-8457
Practice Address - Country:US
Practice Address - Phone:253-862-2138
Practice Address - Fax:253-862-2947
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60752989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor