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General NPI Number Information
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NPI Number | 1417085291
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Entity Type | Individual
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Provider Name | MICHAEL WAYNE HEADLEE D.C.
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Gender | Male
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 10/26/2017
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Provider Practice Location Address
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Address Line | 1426 BEMIDJI AVE N STE 2
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City | BEMIDJI
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State | MN
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Zip | 56601-3882
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Country | US
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Telephone | 218-333-8811
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Fax | 218-333-8813
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Provider Business Mailing Address
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Address Line | 1426 BEMIDJI AVE N STE 2
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City | BEMIDJI
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State | MN
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Zip | 56601-3882
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Country | US
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Telephone | 218-333-8811
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Fax | 218-333-8813
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4495
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License Number State | MN
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