=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245445527
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SEAN JASON HELLER D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1097 MAIN ST
-----------------------------------------------------
City | HOPE VALLEY
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02832-1610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-491-9287
-----------------------------------------------------
Fax | 401-491-9166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 1099
-----------------------------------------------------
City | HOPE VALLEY
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-491-9287
-----------------------------------------------------
Fax | 401-491-9166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DCP00538
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------