Provider Demographics
NPI:1093806432
Name:HEDRICK, EARL ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:ROBERT
Last Name:HEDRICK
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 1:215 FRANKLIN PARKE CT
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-4459
Mailing Address - Country:US
Mailing Address - Phone:540-382-6502
Mailing Address - Fax:540-382-6502
Practice Address - Street 1:4504 STARKEY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-8540
Practice Address - Country:US
Practice Address - Phone:540-774-2513
Practice Address - Fax:540-774-0669
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104002093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA350001064Medicare ID - Type UnspecifiedMEDICARE NUMBER
VAU71998Medicare UPIN