Provider Demographics
NPI:1144377250
Name:HESTER, BRIAN K (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:K
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 1:303 S COMMERCIAL ST
Mailing Address - Street 2:STE 10
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-2125
Mailing Address - Country:US
Mailing Address - Phone:618-252-5555
Mailing Address - Fax:
Practice Address - Street 1:303 S COMMERCIAL ST
Practice Address - Street 2:STE 10
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-2125
Practice Address - Country:US
Practice Address - Phone:618-252-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-006763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038-006763Medicaid
IL083-82007OtherBLUE CROSS BLUE SHIELD
IL038-006763OtherLICENSE #
ILU10333Medicare UPIN
IL038-006763Medicaid