Provider Demographics
NPI:1982755203
Name:ALVIDREZ, HEATH R (DC)
Entity type:Individual
Prefix:DR
First Name:HEATH
Middle Name:R
Last Name:ALVIDREZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 MESQUITE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5773
Mailing Address - Country:US
Mailing Address - Phone:928-855-2069
Mailing Address - Fax:982-855-3909
Practice Address - Street 1:1940 MESQUITE AVE STE A
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5773
Practice Address - Country:US
Practice Address - Phone:928-855-2069
Practice Address - Fax:982-855-3909
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7502111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor