Provider Demographics
NPI:1275198384
Name:HEDLUND, KYLE DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:DEAN
Last Name:HEDLUND
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 1:5002 S 235TH ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-3022
Mailing Address - Country:US
Mailing Address - Phone:785-259-3700
Mailing Address - Fax:
Practice Address - Street 1:5002 S 235TH ST
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-3022
Practice Address - Country:US
Practice Address - Phone:785-259-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-03
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019014752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor