Healthcare Provider Details

I. General information

NPI: 1316231236
Provider Name (Legal Business Name): MARK ANDREW HESLIP D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 PINE ST SUIT 103
SAN FRANCISCO CA
94104-3327
US

IV. Provider business mailing address

369 PINE ST SUIT 103
SAN FRANCISCO CA
94104-3327
US

V. Phone/Fax

Practice location:
  • Phone: 415-989-7200
  • Fax:
Mailing address:
  • Phone: 415-989-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number22001
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: