Provider Demographics
NPI:1306177258
Name:HEDIGER CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:HEDIGER CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEDIGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-235-7221
Mailing Address - Street 1:3858 LAKE ST
Mailing Address - Street 2:STE 20
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7682
Mailing Address - Country:US
Mailing Address - Phone:907-235-7221
Mailing Address - Fax:907-235-3430
Practice Address - Street 1:3858 LAKE ST
Practice Address - Street 2:STE 20
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7682
Practice Address - Country:US
Practice Address - Phone:907-235-7221
Practice Address - Fax:907-235-3430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty