Provider Demographics
NPI:1407192362
Name:HEID, DANE MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:DANE
Middle Name:MICHAEL
Last Name:HEID
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N 14TH ST
Mailing Address - Street 2:3A
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0697
Mailing Address - Country:US
Mailing Address - Phone:701-751-3070
Mailing Address - Fax:701-751-3071
Practice Address - Street 1:3000 N 14TH ST
Practice Address - Street 2:3A
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0697
Practice Address - Country:US
Practice Address - Phone:701-751-3070
Practice Address - Fax:701-751-3071
Is Sole Proprietor?:No
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND931111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND931Medicare PIN