Healthcare Provider Details

I. General information

NPI: 1396331922
Provider Name (Legal Business Name): HEIDI KAY ZOOK DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 2ND ST S
BUFFALO MN
55313-1413
US

IV. Provider business mailing address

2302 PRAIRIE VIEW LN
BUFFALO MN
55313-2270
US

V. Phone/Fax

Practice location:
  • Phone: 763-682-5306
  • Fax: 763-684-1758
Mailing address:
  • Phone: 763-682-5306
  • Fax: 763-684-1758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4320
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: