Individual
DYLAN HEDRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2701 17TH ST, ROCK ISLAND, IL 61201-5351
(309) 779-3048
Mailing address
2701 17TH ST, ROCK ISLAND, IL 61201-5351
(309) 779-3048
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
362739299001
TRICARE WEST
—
01
—
362739299014
TRICARE 7TH
—
01
—
94217
BCWELLMARK 7TH
—
01
—
95201
BCWELLMARK WEST
—
01
—
IL0181
JOHN DEERE
—
Enumeration date
02/24/2006
Last updated
02/28/2008
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