Provider Demographics
NPI:1619059029
Name:HADY, JEFFREY F (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:F
Last Name:HADY
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 1:5663 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2279111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN238827800Medicaid
MN350052698OtherRAIL ROAD MEDICARE
MN4423422OtherCHIROCARE
MN74414HAOtherBLUE CROSS & BLUE SHIELD
MN4448132OtherMEDICA
MN74414HAOtherBLUE CROSS & BLUE SHIELD
MN350052698OtherRAIL ROAD MEDICARE