Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 6452 | MN |
N | 111NN1001X | Nutrition | 6452 | MN |
NPI | 1144787797 |
---|---|
Provider Name | Heidi Lynn Culbertson |
First Address | Ramsey, MN 55303-5721 |
Second Address | Ramsey, MN 55303-5721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2019 |
Last Update Date | 01/03/2019 |