Provider Demographics
NPI:1316008766
Name:HEDRICK, JERRY ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:ALLEN
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 1:1658 PLEASURE HOUSE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-4051
Mailing Address - Country:US
Mailing Address - Phone:757-464-5300
Mailing Address - Fax:757-464-5445
Practice Address - Street 1:1658 PLEASURE HOUSE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-4051
Practice Address - Country:US
Practice Address - Phone:757-464-5300
Practice Address - Fax:757-464-5445
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAJH1037632OtherASHN
VA176572OtherANTHEM
VA1037632OtherOPTIMA
VAJH1037632OtherASHN