Provider Demographics
NPI:1093912040
Name:KESTLER CHIROPRACTIC CLINIC,LLC
Entity Type:Organization
Organization Name:KESTLER CHIROPRACTIC CLINIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:CLAUDE
Authorized Official - Last Name:KESTLER
Authorized Official - Suffix:I
Authorized Official - Credentials:DC
Authorized Official - Phone:361-552-4040
Mailing Address - Street 1:2203 N HWY 35
Mailing Address - Street 2:#A
Mailing Address - City:PORT LAVACA
Mailing Address - State:TX
Mailing Address - Zip Code:77979-5208
Mailing Address - Country:US
Mailing Address - Phone:361-552-4040
Mailing Address - Fax:361-552-0908
Practice Address - Street 1:2203 N HWY 35
Practice Address - Street 2:#A
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-5208
Practice Address - Country:US
Practice Address - Phone:361-552-4040
Practice Address - Fax:361-552-0908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00610RMedicare PIN