Provider Demographics
NPI:1144787797
Name:CULBERTSON, HEIDI LYNN (DC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYNN
Last Name:CULBERTSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:LYNN
Other - Last Name:IVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:7378 147TH LN NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-5721
Mailing Address - Country:US
Mailing Address - Phone:763-234-8490
Mailing Address - Fax:
Practice Address - Street 1:7378 147TH LN NW
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-5721
Practice Address - Country:US
Practice Address - Phone:763-234-8490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6452111NN1001X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition