Provider Demographics
NPI:1962409631
Name:HEDIGER, KEITH L (DC)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:L
Last Name:HEDIGER
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 1:3858 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
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH0124Medicaid
AKCH0124Medicaid