Provider Demographics
NPI:1699542654
Name:GARRISON, HEATHER RENA (DC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENA
Last Name:GARRISON
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 1:224 SE 9TH AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-4040
Mailing Address - Country:US
Mailing Address - Phone:336-225-4695
Mailing Address - Fax:
Practice Address - Street 1:7119 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2210
Practice Address - Country:US
Practice Address - Phone:954-417-5815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor