Provider Demographics
NPI:1124365911
Name:WESTERN, HEIDI J (DC)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:J
Last Name:WESTERN
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 1:825 28TH STREET SOUTH
Mailing Address - Street 2:SUITE A
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2325
Mailing Address - Country:US
Mailing Address - Phone:952-412-9517
Mailing Address - Fax:
Practice Address - Street 1:825 28TH STREET SOUTH
Practice Address - Street 2:SUITE A
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2325
Practice Address - Country:US
Practice Address - Phone:952-412-9517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor