Provider Demographics
NPI:1437517521
Name:MENDENHALL, HEIDI LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:LEE
Last Name:MENDENHALL
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 1:101 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:MN
Mailing Address - Zip Code:55369-1227
Mailing Address - Country:US
Mailing Address - Phone:612-308-7504
Mailing Address - Fax:
Practice Address - Street 1:101 1ST ST NE
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:MN
Practice Address - Zip Code:55369-1227
Practice Address - Country:US
Practice Address - Phone:612-308-7504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5903111NR0200X
CA32550111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology