Healthcare Provider Details

I. General information

NPI: 1356650576
Provider Name (Legal Business Name): NICOLE KRISTINE HEILSBERG L.M.P., D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 NW NYE ST
PULLMAN WA
99163-3428
US

IV. Provider business mailing address

107 N SKYVIEW DR
COLFAX WA
99111-1994
US

V. Phone/Fax

Practice location:
  • Phone: 509-334-1241
  • Fax:
Mailing address:
  • Phone: 509-397-2602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberMA00022917
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 60540639
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: