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Individual
MR. NATHAN JOSEPH HEIDE
Active
Individual
MR. NATHAN JOSEPH HEIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DAOM LAC
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
164157
OR
171100000X
Acupuncturist
21349
CA
171100000X
Acupuncturist
Primary
AC164157
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
154326
NCCAOM CERTIFICATE
OR
01
—
164157
OREGON ACUPUNCTURE LICENSE
OR
01
—
21349
CALIFORNIA ACUPUNCTURE LICENSE
CA
Enumeration date
08/08/2013
Last updated
11/08/2016
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