Provider Demographics
NPI:1326246810
Name:HEIL CHIROPRACTIC CENTER PA
Entity Type:Organization
Organization Name:HEIL CHIROPRACTIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:HEIL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-323-4855
Mailing Address - Street 1:13849 ROUND LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55304
Mailing Address - Country:US
Mailing Address - Phone:763-323-4855
Mailing Address - Fax:
Practice Address - Street 1:3507 ROUND LAKE BLVD NW
Practice Address - Street 2:300
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-5001
Practice Address - Country:US
Practice Address - Phone:763-323-4855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC04122Medicare PIN