Healthcare Provider Details

I. General information

NPI: 1225334394
Provider Name (Legal Business Name): EDYTHE M HEUS D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33004 CHRISTINA DR
DANA POINT CA
92629-1040
US

IV. Provider business mailing address

33004 CHRISTINA DR
DANA POINT CA
92629-1040
US

V. Phone/Fax

Practice location:
  • Phone: 949-429-2247
  • Fax: 949-429-1643
Mailing address:
  • Phone: 949-429-2247
  • Fax: 949-429-1643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-26403
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: