MEDICARE: DR. SUSAN LAURIE HERDA DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NX0800X	Orthopedic Chiropractor	4872	MN

General Provider Information

NPI Number	:	1659341840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN LAURIE HERDA DC

Provider Business Mailing Address
First Line	:	4960 HIGHWAY 12
Second Line	:
City	:	MAPLE PLAIN
State	:	MN
Zip	:	55359-8729
Country	:	US
Telephone Number	:	763-479-3388
Fax Number	:	763-479-6258

Provider Business Practice Location Address
First Line	:	4960 HIGHWAY 12
Second Line	:
City	:	MAPLE PLAIN
State	:	MN
Zip	:	55359-8729
Country	:	US
Telephone Number	:	763-479-3388
Fax Number	:	763-479-6258

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	08/20/2020

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