Provider Demographics
NPI:1275938706
Name:HAGEDORN, ADRIENNE ANN (DC)
Entity Type:Individual
Prefix:MISS
First Name:ADRIENNE
Middle Name:ANN
Last Name:HAGEDORN
Suffix:
Gender:F
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:P.O. BOX 244
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-2619
Mailing Address - Country:US
Mailing Address - Phone:812-448-8404
Mailing Address - Fax:812-443-1427
Practice Address - Street 1:501 E US HWY 40
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-2633
Practice Address - Country:US
Practice Address - Phone:812-448-8404
Practice Address - Fax:812-443-1427
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002796A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor