Healthcare Provider Details

I. General information

NPI: 1932257177
Provider Name (Legal Business Name): HEIDI BETH CHURGIN AP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 SW 26TH AVE
POMPANO BEACH FL
33069-4315
US

IV. Provider business mailing address

651 SE 5TH TER
POMPANO BEACH FL
33060-8127
US

V. Phone/Fax

Practice location:
  • Phone: 954-933-0555
  • Fax: 954-942-6780
Mailing address:
  • Phone: 954-933-0555
  • Fax: 954-942-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP1173
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: