Healthcare Provider Details

I. General information

NPI: 1760250302
Provider Name (Legal Business Name): HEATHER MARIE DRAXLER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 EGAN DR STE 201
SAVAGE MN
55378-3303
US

IV. Provider business mailing address

7206 W 114TH STREET CIR
BLOOMINGTON MN
55438-2803
US

V. Phone/Fax

Practice location:
  • Phone: 952-447-3343
  • Fax:
Mailing address:
  • Phone: 952-797-2570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number4002
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: