Provider Demographics
NPI:1023010097
Name:HESTER, KIM W (DC)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:W
Last Name:HESTER
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 1:6922 S LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3913
Mailing Address - Country:US
Mailing Address - Phone:918-551-6567
Mailing Address - Fax:918-508-7403
Practice Address - Street 1:6922 S LEWIS
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136
Practice Address - Country:US
Practice Address - Phone:918-551-6567
Practice Address - Fax:918-508-7403
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4186111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP00099384OtherRAILROAD MEDICARE
UTU79294Medicare UPIN
UT000056262Medicare ID - Type UnspecifiedMEDICARE
UT460489865OtherFEDERAL TAX ID