Healthcare Provider Details

I. General information

NPI: 1780697052
Provider Name (Legal Business Name): DR. CHARLES EDWIN HEGEDUS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9199 STAPLES MILL RD SUITE 2E
RICHMOND VA
23228-2027
US

IV. Provider business mailing address

9199 STAPLES MILL RD SUITE 2E
RICHMOND VA
23228-2027
US

V. Phone/Fax

Practice location:
  • Phone: 804-672-1222
  • Fax: 804-672-3269
Mailing address:
  • Phone: 804-672-1222
  • Fax: 804-672-3269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104001155
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: