Provider Demographics
NPI:1750339644
Name:HEDIGER, CRAIG BRUCE (DC)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:BRUCE
Last Name:HEDIGER
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 1:101 W PARKS HWY
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654
Mailing Address - Country:US
Mailing Address - Phone:907-376-4851
Mailing Address - Fax:907-373-4851
Practice Address - Street 1:101 W PARKS HWY
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-376-4851
Practice Address - Fax:907-373-4851
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK138111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH0074Medicaid
T67025Medicare UPIN
AKCH0074Medicaid