Provider Demographics
NPI:1205908902
Name:HELLERUD, LISA FAYE (DC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:FAYE
Last Name:HELLERUD
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 1:7975 AFTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1544
Mailing Address - Country:US
Mailing Address - Phone:651-730-7302
Mailing Address - Fax:651-730-9671
Practice Address - Street 1:7975 AFTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1544
Practice Address - Country:US
Practice Address - Phone:651-730-7302
Practice Address - Fax:651-730-9671
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3229111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU67885Medicare UPIN