Healthcare Provider Details

I. General information

NPI: 1689748394
Provider Name (Legal Business Name): DEAN PATRICK HEGARTY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2933 S FLORIDA AVE STE 7
LAKELAND FL
33803-4037
US

IV. Provider business mailing address

2933 S FLORIDA AVE STE 7
LAKELAND FL
33803-4037
US

V. Phone/Fax

Practice location:
  • Phone: 916-800-4947
  • Fax: 916-635-7966
Mailing address:
  • Phone: 916-800-4947
  • Fax: 916-635-7966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number13264
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: