1982794608 NPI number — DR. DEBORAH HEIM D.C.

Table of content: DR. DEBORAH HEIM D.C. (NPI 1982794608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982794608 NPI number — DR. DEBORAH HEIM D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEIM
Provider First Name:
DEBORAH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982794608
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7101 HIGHWAY 65 NE STE 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRIDLEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55432-3349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-482-9160
Provider Business Mailing Address Fax Number:
651-925-0053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7101 HIGHWAY 65 NE STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRIDLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55432-3349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-482-9160
Provider Business Practice Location Address Fax Number:
651-925-0053
Provider Enumeration Date:
10/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2712 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 064528100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2C924HE . This is a "BCBSM" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".