Provider Demographics
NPI:1477011666
Name:EDGE, HAYDEN (DC)
Entity type:Individual
Prefix:
First Name:HAYDEN
Middle Name:
Last Name:EDGE
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 1:3460 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-1837
Mailing Address - Country:US
Mailing Address - Phone:901-626-1931
Mailing Address - Fax:
Practice Address - Street 1:3400 INDUSTRIAL LN UNIT 1A
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1650
Practice Address - Country:US
Practice Address - Phone:901-626-1931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2023-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0008671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty