Provider Demographics
NPI:1629384540
Name:HEDRICK, RICHARD EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EDWARD
Last Name:HEDRICK
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 1:8950 VILLA LA JOLLA DR
Mailing Address - Street 2:STE B212
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1708
Mailing Address - Country:US
Mailing Address - Phone:858-558-3111
Mailing Address - Fax:858-558-3641
Practice Address - Street 1:8950 VILLA LA JOLLA DR
Practice Address - Street 2:STE B212
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1708
Practice Address - Country:US
Practice Address - Phone:858-558-3111
Practice Address - Fax:858-558-3641
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31759111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor