Provider Demographics
NPI:1467637439
Name:HEBRINK, TANYA MAY (DC)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:MAY
Last Name:HEBRINK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:MAY
Other - Last Name:CHRISTENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-0327
Mailing Address - Country:US
Mailing Address - Phone:218-259-8254
Mailing Address - Fax:218-326-6927
Practice Address - Street 1:1415 E US HIGHWAY 169
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-3375
Practice Address - Country:US
Practice Address - Phone:218-326-1030
Practice Address - Fax:218-326-6927
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNTBA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN455060900Medicaid
MN5078OtherCHIROPRACTIC LICENSE
MN350005022Medicare UPIN