MEDICARE: PINNACLE CHIROPRACTIC AND REHAB PLLC

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

General Provider Information

NPI Number	:	1962171819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE CHIROPRACTIC AND REHAB PLLC

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	:	OWNER
Name	:	JEREMY M HEIDT
Credential	:	DC
Telephone Number	:	701-290-9494

Provider Enumeration Date	:	09/13/2021
Last Update Date	:	02/17/2022

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