Healthcare Provider Details

I. General information

NPI: 1710277199
Provider Name (Legal Business Name): CARL HEATH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5509 COLLEYVILLE BLVD STE 100
COLLEYVILLE TX
76034-7807
US

IV. Provider business mailing address

P.O. BOX 677449
DALLAS TX
75267
US

V. Phone/Fax

Practice location:
  • Phone: 817-479-0055
  • Fax: 817-479-0058
Mailing address:
  • Phone: 630-754-8788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11747
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: