Provider Demographics
NPI:1720291610
Name:HEYER, GAYLE NICOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:NICOLE
Last Name:HEYER
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 1:744 STONEBURY CIR
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-7795
Mailing Address - Country:US
Mailing Address - Phone:803-386-3912
Mailing Address - Fax:803-403-8216
Practice Address - Street 1:744 STONEBURY CIR
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-7795
Practice Address - Country:US
Practice Address - Phone:803-386-3912
Practice Address - Fax:803-403-8216
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH3225Medicaid