Healthcare Provider Details

I. General information

NPI: 1366688467
Provider Name (Legal Business Name): HELLER CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2008
Last Update Date: 12/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 BRISTOL ST STE C105
COSTA MESA CA
92626-5944
US

IV. Provider business mailing address

2900 BRISTOL ST STE C105
COSTA MESA CA
92626-5944
US

V. Phone/Fax

Practice location:
  • Phone: 714-557-9454
  • Fax:
Mailing address:
  • Phone: 714-557-9454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC24405
License Number StateCA

VIII. Authorized Official

Name: DR. BRIAN GORDON HELLER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 714-557-9454