Provider Demographics
NPI:1093802506
Name:DONNA J. HEDGEPETH, DC, PA
Entity Type:Organization
Organization Name:DONNA J. HEDGEPETH, DC, PA
Other - Org Name:KEYSTONE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEDGEPETH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-851-1010
Mailing Address - Street 1:4615 WESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-1815
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4615 WESTERN BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-1815
Practice Address - Country:US
Practice Address - Phone:919-851-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085JWMedicaid
NC89085JWMedicaid
NC2455145Medicare ID - Type Unspecified