Provider Demographics
NPI:1073503579
Name:HEDBERG, NIKOLAS ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:NIKOLAS
Middle Name:ROBERT
Last Name:HEDBERG
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 1:2144 HENDERSONVILLE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-5705
Mailing Address - Country:US
Mailing Address - Phone:828-687-2344
Mailing Address - Fax:828-687-2302
Practice Address - Street 1:2144 HENDERSONVILLE RD
Practice Address - Street 2:SUITE B
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-5705
Practice Address - Country:US
Practice Address - Phone:828-687-2344
Practice Address - Fax:828-687-2302
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3256111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC667614OtherACN
NC89085RVMedicaid
NC085RVOtherBCBS
NC89085RVMedicaid