Provider Demographics
NPI:1750686036
Name:HEIDT, JEREMY MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:MICHAEL
Last Name:HEIDT
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 1:3259 OAK RIDGE LOOP E
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8482
Mailing Address - Country:US
Mailing Address - Phone:701-532-1699
Mailing Address - Fax:701-532-0815
Practice Address - Street 1:3259 OAK RIDGE LOOP E
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-8482
Practice Address - Country:US
Practice Address - Phone:701-532-1699
Practice Address - Fax:701-532-0815
Is Sole Proprietor?:No
Enumeration Date:2011-01-19
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5456111N00000X
ND1152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor