Provider Demographics
NPI:1194153932
Name:HERON, DAVID (LAC, DACM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:HERON
Suffix:
Gender:M
Credentials:LAC, DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 KELLER AVE
Mailing Address - Street 2:STE 250
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-4281
Mailing Address - Country:US
Mailing Address - Phone:510-982-1875
Mailing Address - Fax:
Practice Address - Street 1:4400 KELLER AVE
Practice Address - Street 2:STE 250
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-4281
Practice Address - Country:US
Practice Address - Phone:510-982-1875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-14
Last Update Date:2019-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 15595171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist