Healthcare Provider Details

I. General information

NPI: 1982079356
Provider Name (Legal Business Name): ERICA GRACE HEPPE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERICA GRACE LOWE D.C.

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 FREDERICK ST
FREDERICKSBURG VA
22401
US

IV. Provider business mailing address

311 FREDERICK ST
FREDERICKSBURG VA
22401
US

V. Phone/Fax

Practice location:
  • Phone: 540-891-9191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104-557280
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: