Provider Demographics
NPI:1801847371
Name:HEDIGER, POLLY A (DC)
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:A
Last Name:HEDIGER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5810 S HIGHWAY 95
Mailing Address - Street 2:STE. 2
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-6076
Mailing Address - Country:US
Mailing Address - Phone:928-768-1122
Mailing Address - Fax:
Practice Address - Street 1:5810 S HIGHWAY 95
Practice Address - Street 2:STE. 2
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-6076
Practice Address - Country:US
Practice Address - Phone:928-768-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7406111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ115941Medicare PIN