Provider Demographics
NPI:1932215225
Name:HEISE, DOUGLAS (DC, DACBN)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:HEISE
Suffix:
Gender:M
Credentials:DC, DACBN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3592 ALOMA AVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4012
Mailing Address - Country:US
Mailing Address - Phone:407-677-1660
Mailing Address - Fax:407-677-8252
Practice Address - Street 1:3592 ALOMA AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4012
Practice Address - Country:US
Practice Address - Phone:407-677-1660
Practice Address - Fax:407-677-8252
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0001603111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT85945Medicare UPIN