Provider Demographics
NPI:1851424147
Name:SCOTT W HEDRICK DCPA
Entity Type:Organization
Organization Name:SCOTT W HEDRICK DCPA
Other - Org Name:HEDRICK CHIROPRACTIC & NUTRITION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:W
Authorized Official - Last Name:HEDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DCPA
Authorized Official - Phone:954-987-2220
Mailing Address - Street 1:3475 SHERIDAN ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3663
Mailing Address - Country:US
Mailing Address - Phone:954-987-2220
Mailing Address - Fax:
Practice Address - Street 1:3475 SHERIDAN ST
Practice Address - Street 2:SUITE 207
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3663
Practice Address - Country:US
Practice Address - Phone:954-987-2220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005834111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050928100Medicaid
FLAH683Medicare PIN