Provider Demographics
NPI:1144508490
Name:HEIDT, JENNY MARIE (DC)
Entity type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:MARIE
Last Name:HEIDT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:JENNY
Other - Middle Name:MARIE
Other - Last Name:BACHMEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:8941 AZTEC DRIVE
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347
Mailing Address - Country:US
Mailing Address - Phone:952-303-4590
Mailing Address - Fax:952-303-4708
Practice Address - Street 1:8941 AZTEC DRIVE
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347
Practice Address - Country:US
Practice Address - Phone:952-303-4590
Practice Address - Fax:952-303-4708
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5567111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor