Healthcare Provider Details

I. General information

NPI: 1033289079
Provider Name (Legal Business Name): TIANA D. HEJDUK D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 SANTA FE DR STE A
ENCINITAS CA
92024-5144
US

IV. Provider business mailing address

876 SANDCASTLE DR
CARDIFF BY THE SEA CA
92007-1124
US

V. Phone/Fax

Practice location:
  • Phone: 760-944-8877
  • Fax: 760-944-8897
Mailing address:
  • Phone: 760-822-4038
  • Fax: 760-944-8897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 29407
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: