Healthcare Provider Details

I. General information

NPI: 1558346668
Provider Name (Legal Business Name): GREGORY VADEN HEDGEPETH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MAIN AVE STE 2A
CLIFTON NJ
07011-2266
US

IV. Provider business mailing address

220 MAIN ST APT 202
LITTLE FALLS NJ
07424-1382
US

V. Phone/Fax

Practice location:
  • Phone: 973-632-4925
  • Fax:
Mailing address:
  • Phone: 973-632-4925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00563300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: