Provider Demographics
NPI:1982853511
Name:WORTHINGTON, HEATHER LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:LYNN
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3348 SHERMAN CT
Mailing Address - Street 2:#103
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-5006
Mailing Address - Country:US
Mailing Address - Phone:651-207-6536
Mailing Address - Fax:651-207-6549
Practice Address - Street 1:3348 SHERMAN CT
Practice Address - Street 2:UNIT 103
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-5006
Practice Address - Country:US
Practice Address - Phone:651-207-6536
Practice Address - Fax:651-207-6549
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor