MEDICARE: DR. JEREMY MICHAEL HEIDT D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5456	MN
2	111N00000X	Chiropractor	1152	ND

General Provider Information

NPI Number	:	1750686036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY MICHAEL HEIDT D.C.

Provider Business Mailing Address
First Line	:	3259 OAK RIDGE LOOP E
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-8482
Country	:	US
Telephone Number	:	701-532-1699
Fax Number	:	701-532-0815

Provider Business Practice Location Address
First Line	:	3259 OAK RIDGE LOOP E
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-8482
Country	:	US
Telephone Number	:	701-532-1699
Fax Number	:	701-532-0815

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2011
Last Update Date	:	02/17/2022

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