Provider Demographics
NPI:1194556423
Name:HEDRICK, JAKE ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:JAKE
Middle Name:ANTHONY
Last Name:HEDRICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 WATER ST STE C1
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4128
Mailing Address - Country:US
Mailing Address - Phone:831-426-6450
Mailing Address - Fax:
Practice Address - Street 1:550 WATER ST STE C1
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4128
Practice Address - Country:US
Practice Address - Phone:831-426-6450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37055111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor