Provider Demographics
NPI:1740877687
Name:HEISEL, PAULIE D (DC)
Entity type:Individual
Prefix:DR
First Name:PAULIE
Middle Name:D
Last Name:HEISEL
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 1:3430 NE 66TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-4565
Mailing Address - Country:US
Mailing Address - Phone:971-599-3512
Mailing Address - Fax:844-888-1211
Practice Address - Street 1:3939 NE HANCOCK ST # 303
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-5321
Practice Address - Country:US
Practice Address - Phone:971-599-3512
Practice Address - Fax:844-888-1211
Is Sole Proprietor?:No
Enumeration Date:2020-12-27
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9221111N00000X
OR6123111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor