Provider Demographics
NPI:1760153548
Name:HERITAGE CLINIC OF CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:HERITAGE CLINIC OF CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEDGES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-990-0036
Mailing Address - Street 1:29 GRANDVIEW AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1039
Mailing Address - Country:US
Mailing Address - Phone:740-990-0036
Mailing Address - Fax:
Practice Address - Street 1:29 GRANDVIEW AVE STE B
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1039
Practice Address - Country:US
Practice Address - Phone:740-990-0036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty