Provider Demographics
NPI:1124108642
Name:PRITCHARD, HEATHER DAWN (DC)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:DAWN
Last Name:PRITCHARD
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 1:10641 GREENBRIER RD
Mailing Address - Street 2:APT 224
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-6401
Mailing Address - Country:US
Mailing Address - Phone:612-920-1092
Mailing Address - Fax:612-928-0375
Practice Address - Street 1:5050 W 36TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-5469
Practice Address - Country:US
Practice Address - Phone:612-920-1092
Practice Address - Fax:612-928-0375
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4562111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN884S3PROtherBCBS PROVIDER ID
MN884S3PROtherBCBS PROVIDER ID