Provider Demographics
NPI:1023103694
Name:HEISERMAN, CYNTHIA (DC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:HEISERMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 EMERSON AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-2522
Mailing Address - Country:US
Mailing Address - Phone:612-529-2218
Mailing Address - Fax:
Practice Address - Street 1:3511 EMERSON AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-2522
Practice Address - Country:US
Practice Address - Phone:612-529-2218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN06921HEOtherBCBS PROVIDER #
MNOC363HEOtherBCBS INDIVIDUAL PROVIDER
MNOC363HEOtherBCBS INDIVIDUAL PROVIDER