Provider Demographics
NPI:1578577235
Name:KARLS, HEATHER ANNE WIELDE (DC, CCSP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ANNE WIELDE
Last Name:KARLS
Suffix:
Gender:F
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 CLEVELAND AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1345
Mailing Address - Country:US
Mailing Address - Phone:651-699-8610
Mailing Address - Fax:651-699-1207
Practice Address - Street 1:730 CLEVELAND AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1345
Practice Address - Country:US
Practice Address - Phone:651-699-8610
Practice Address - Fax:651-699-1207
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3386111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5C509KAOtherBLUECROSS BLUESHIELD
MN350041729OtherRAILROAD MEDICARE
MN483216700Medicaid
MNU63944Medicare UPIN
MN350001520Medicare ID - Type Unspecified
MN350001520Medicare PIN
MN350041729Medicare PIN