Healthcare Provider Details

I. General information

NPI: 1487966651
Provider Name (Legal Business Name): RIVER HEIGHTS CLINIC OF CHIROPRACTIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2010
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5759 BLAINE AVE
INVER GROVE HEIGHTS MN
55076-1225
US

IV. Provider business mailing address

16580 JAVELIN AVE
LAKEVILLE MN
55044-8784
US

V. Phone/Fax

Practice location:
  • Phone: 651-756-7941
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN DOUGLAS HETLAND
Title or Position: OWNER
Credential: D.C.
Phone: 612-723-5272