Provider Demographics
NPI:1780129692
Name:TJEPKES, HEATHER CHRISTINE (DC)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:CHRISTINE
Last Name:TJEPKES
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 1:22388 BLACKDUCK LAKE RD NE
Mailing Address - Street 2:
Mailing Address - City:BLACKDUCK
Mailing Address - State:MN
Mailing Address - Zip Code:56630-4226
Mailing Address - Country:US
Mailing Address - Phone:218-841-8109
Mailing Address - Fax:
Practice Address - Street 1:22388 BLACKDUCK LAKE RD NE
Practice Address - Street 2:
Practice Address - City:BLACKDUCK
Practice Address - State:MN
Practice Address - Zip Code:56630-4226
Practice Address - Country:US
Practice Address - Phone:218-841-8109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-31
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor