Provider Demographics
NPI:1790308211
Name:HEIM, DANIEL BENJAMIN (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:BENJAMIN
Last Name:HEIM
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 1:111 MAIN ST N
Mailing Address - Street 2:
Mailing Address - City:STEWARTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55976-1226
Mailing Address - Country:US
Mailing Address - Phone:507-533-8011
Mailing Address - Fax:
Practice Address - Street 1:111 MAIN ST N
Practice Address - Street 2:
Practice Address - City:STEWARTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55976-1226
Practice Address - Country:US
Practice Address - Phone:507-533-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6717111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor