Healthcare Provider Details

I. General information

NPI: 1801325980
Provider Name (Legal Business Name): ADAM RANDY HEIN L. AC., M. OM.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 06/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9325 UPLAND LN N STE 240
MAPLE GROVE MN
55369-4486
US

IV. Provider business mailing address

4744 12TH AVE S
MINNEAPOLIS MN
55407-3508
US

V. Phone/Fax

Practice location:
  • Phone: 763-494-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1837
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: