Provider Demographics
NPI:1194963397
Name:ELLIS, HEATHER KAYE (DC)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:KAYE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 W HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-4836
Mailing Address - Country:US
Mailing Address - Phone:817-487-0099
Mailing Address - Fax:682-292-2982
Practice Address - Street 1:908 W HENDERSON ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4836
Practice Address - Country:US
Practice Address - Phone:817-487-0099
Practice Address - Fax:682-292-2982
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor