Provider Demographics
NPI:1417597592
Name:HEDGES, NICHOLAS ANDREW (DC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ANDREW
Last Name:HEDGES
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 1:114 VILLAGE PL
Mailing Address - Street 2:SUITE 302
Mailing Address - City:DILLON
Mailing Address - State:CO
Mailing Address - Zip Code:80435
Mailing Address - Country:US
Mailing Address - Phone:281-520-7172
Mailing Address - Fax:
Practice Address - Street 1:114 VILLAGE PL
Practice Address - Street 2:SUITE 302
Practice Address - City:DILLON
Practice Address - State:CO
Practice Address - Zip Code:80435
Practice Address - Country:US
Practice Address - Phone:281-520-7172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0008136111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor