Provider Demographics
NPI:1548311384
Name:HEATHCOTT, GINA ANN (DC)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:ANN
Last Name:HEATHCOTT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2156B N HIGHLAND AVE # 109
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-4953
Mailing Address - Country:US
Mailing Address - Phone:731-661-0390
Mailing Address - Fax:731-664-6697
Practice Address - Street 1:384 CARRIAGE HOUSE DR STE C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2268
Practice Address - Country:US
Practice Address - Phone:731-661-0390
Practice Address - Fax:731-664-6697
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7731111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor