Healthcare Provider Details

I. General information

NPI: 1568555142
Provider Name (Legal Business Name): GREGORY B HEYWOOD D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 30TH ST SUITE 208
SACRAMENTO CA
95816-3359
US

IV. Provider business mailing address

9700 RIO VISTA DR
SACRAMENTO CA
95837-1005
US

V. Phone/Fax

Practice location:
  • Phone: 916-444-8390
  • Fax: 916-444-1938
Mailing address:
  • Phone: 916-921-2806
  • Fax: 916-927-2164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11204
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: