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NPI Code Detail

MEDICARE: JUSTIN HEESAKKER L.AC.

MEDICARE: JUSTIN HEESAKKER L.AC.
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
1171100000XAcupuncturist1779MN
2171100000XAcupuncturist13454CA

General Provider Information

NPI Number : 1659683126
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN HEESAKKER L.AC.
Provider Business Mailing Address
First Line : 2925 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1321
Country : US
Telephone Number : 612-262-5000
Fax Number :
Provider Business Practice Location Address
First Line : 2833 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1319
Country : US
Telephone Number : 612-863-3333
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2010
Last Update Date : 11/18/2015

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Directions to “ JUSTIN HEESAKKER L.AC.” Practice Location

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