Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 8654 | AZ |
NPI | 1003392549 |
---|---|
Provider Name | Robert Hedeen |
First Address | Phoenix, AZ 85044-3743 |
Second Address | Phoenix, AZ 85044-3743 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2018 |
Last Update Date | 18/07/2018 |