Healthcare Provider Details

I. General information

NPI: 1639181621
Provider Name (Legal Business Name): RUDOLF N HEISER D.C., D.A.C.B.R.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RUDY N HEISER D.C., D.A.C.B.R.

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5775 WAYZATA BLVD STE 190
ST LOUIS PARK MN
55416-2627
US

IV. Provider business mailing address

5775 WAYZATA BLVD STE 400
ST LOUIS PARK MN
55416-1271
US

V. Phone/Fax

Practice location:
  • Phone: 952-541-1840
  • Fax: 952-543-6524
Mailing address:
  • Phone: 952-738-4441
  • Fax: 952-738-4746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number12665531-1202
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number08003437A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number6189-12
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberCH10315
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number7132
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: