Heather Christine Tjepkes, DC
Individual provider Active NPI Chiropractor · Blackduck, MN
NPI 1780129692 · NPPES record last updated Jan 18, 2024
Key facts
- NPI
- 1780129692
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 6315 (MN)
- Practice address
- 22388 Blackduck Lake Rd NE
Blackduck, MN 56630-4226 - Phone
- (218) 841-8109
- NPI assigned
- Dec 31, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170314000079 | MN | Practitioner - Chiropractic | 7618252628 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6315 | MN | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blackduck Chiropractic, LLC | Chiropractor | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 6315 | MN | Yes |
Addresses
Primary practice location
22388 Blackduck Lake Rd NE
Blackduck, MN 56630-4226
Mailing address
22388 Blackduck Lake Rd NE
Blackduck, MN 56630-4226
Phone (218) 841-8109
Other providers in Blackduck, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.