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Individual
MICHLYNN RAE HEIDE
Active
Individual
MICHLYNN RAE HEIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5257
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1639349269
MEDICARE GROUP ID NUMBER
—
01
—
350004449
MEDICARE ID NUMBER
—
01
—
37M47FI
BLUE CROSS GROUP ID NUMBER
—
Enumeration date
08/03/2009
Last updated
06/22/2011
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