Provider Demographics
NPI:1689748394
Name:HEGARTY, DEAN PATRICK (DC)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:PATRICK
Last Name:HEGARTY
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 1:2933 S FLORIDA AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-4037
Mailing Address - Country:US
Mailing Address - Phone:916-800-4947
Mailing Address - Fax:916-635-7966
Practice Address - Street 1:2933 S FLORIDA AVE STE 7
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4037
Practice Address - Country:US
Practice Address - Phone:916-800-4947
Practice Address - Fax:916-635-7966
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13264111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0202160OtherLICENSE NUMBER
CADC0202160OtherLICENSE NUMBER