Provider Demographics
NPI:1568812550
Name:HIEB, DAVE J (ATC/R)
Entity Type:Individual
Prefix:
First Name:DAVE
Middle Name:J
Last Name:HIEB
Suffix:
Gender:M
Credentials:ATC/R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 SNELLING AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1501
Mailing Address - Country:US
Mailing Address - Phone:651-631-5345
Mailing Address - Fax:651-628-3350
Practice Address - Street 1:3003 SNELLING AVENUE N.
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55113
Practice Address - Country:US
Practice Address - Phone:651-631-5345
Practice Address - Fax:651-628-3350
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1192174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty