Provider Demographics
NPI:1558846899
Name:JEDLICKA, BRENDA MAE (LMT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:MAE
Last Name:JEDLICKA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:MAE
Other - Last Name:SEASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:2008 E NORTHERN LIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4101
Mailing Address - Country:US
Mailing Address - Phone:907-646-2266
Mailing Address - Fax:
Practice Address - Street 1:2008 E NORTHERN LIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4101
Practice Address - Country:US
Practice Address - Phone:907-274-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK108329111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation