Provider Demographics
NPI:1326022351
Name:HEDGEPETH, DONNA JEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:JEAN
Last Name:HEDGEPETH
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 1:4615 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:919-851-1010
Mailing Address - Fax:919-859-4254
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:919-859-4254
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085JWMedicaid
NC89085JWMedicaid
491787Medicare UPIN