Provider Demographics
NPI:1649622143
Name:CHAMPION, HEATHER (DC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:HASTINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1047 GLENBROOK WAY STE 112
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-1309
Mailing Address - Country:US
Mailing Address - Phone:813-340-4611
Mailing Address - Fax:
Practice Address - Street 1:1047 GLENBROOK WAY STE 112
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-1309
Practice Address - Country:US
Practice Address - Phone:813-340-4611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11920111N00000X
TN3315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB7SCKOtherFLORIDA BLUE