Provider Demographics
NPI:1588837884
Name:JEFF HADY INC.
Entity Type:Organization
Organization Name:JEFF HADY INC.
Other - Org Name:PIKE LAKE CHIROPRACTIC OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:HADY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-729-8936
Mailing Address - Street 1:5663 MILLER TRUNK HWY
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1229
Mailing Address - Country:US
Mailing Address - Phone:218-729-8936
Mailing Address - Fax:218-729-8944
Practice Address - Street 1:5663 MILLER TRUNK HWY
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-1229
Practice Address - Country:US
Practice Address - Phone:218-729-8936
Practice Address - Fax:218-729-8944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2279111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4423422OtherCHIROCARE
MN4448132OtherMEDICA
MN74414HAOtherBLUE CROSS & BLUE SHIELD
MNT65571Medicare UPIN