MEDICARE: DR. KEITH L HEDIGER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	124	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962409631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH L HEDIGER D.C.

Provider Business Mailing Address
First Line	:	3858 LAKE ST
Second Line	:	STE. 20
City	:	HOMER
State	:	AK
Zip	:	99603-7682
Country	:	US
Telephone Number	:	907-235-7221
Fax Number	:	907-235-3430

Provider Business Practice Location Address
First Line	:	3858 LAKE ST
Second Line	:	STE. 20
City	:	HOMER
State	:	AK
Zip	:	99603-7682
Country	:	US
Telephone Number	:	907-235-7221
Fax Number	:	907-235-3430

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	01/19/2010

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