Provider Demographics
NPI:1306893391
Name:HEDLUND, MICHAEL D (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:HEDLUND
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 1:304 E DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-1830
Mailing Address - Country:US
Mailing Address - Phone:402-336-4222
Mailing Address - Fax:402-336-4228
Practice Address - Street 1:304 E DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763-1830
Practice Address - Country:US
Practice Address - Phone:402-336-4222
Practice Address - Fax:402-336-4228
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47073762101Medicaid
NE091621Medicare ID - Type Unspecified