Provider Demographics
NPI:1588745947
Name:HEDGEPETH, MICHAEL LYNN (DC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LYNN
Last Name:HEDGEPETH
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 1:24770 QUEEN ANNES LACE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613
Mailing Address - Country:US
Mailing Address - Phone:256-216-8180
Mailing Address - Fax:
Practice Address - Street 1:27453 CAPSHAW ROAD SUITE B
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35613
Practice Address - Country:US
Practice Address - Phone:256-216-1006
Practice Address - Fax:256-216-1008
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2075111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51520086OtherBCBS
AL51520086OtherBCBS
AL5734Medicare ID - Type Unspecified