Provider Demographics
NPI:1386601169
Name:HEDGES, KEITH E (DC)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:E
Last Name:HEDGES
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 1:5525 HARROUN ROAD
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560
Mailing Address - Country:US
Mailing Address - Phone:419-882-6455
Mailing Address - Fax:419-882-2880
Practice Address - Street 1:5525 HARROUN ROAD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560
Practice Address - Country:US
Practice Address - Phone:419-882-6455
Practice Address - Fax:419-932-6230
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005948111N00000X
OH672111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0333731Medicaid
OH31091906700OtherBUREAU OF WORKERS COMPENS
OH350001993OtherRAILROAD MEDICARE
OH000000117520OtherANTHEM BCBS
OH955066OtherAETNA HEALTH INC
OH0004279160OtherAETNA
OH310919067005OtherMEDICAL MUTUAL
OH901OtherPARAMOUNT HEALTH CARE
OH0436491Medicare ID - Type Unspecified
OH350001993OtherRAILROAD MEDICARE