Provider Demographics
NPI:1265445829
Name:HESS, BRIAN GREGORY (DC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:GREGORY
Last Name:HESS
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 1:423 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3830
Mailing Address - Country:US
Mailing Address - Phone:626-447-4442
Mailing Address - Fax:626-447-2835
Practice Address - Street 1:423 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3830
Practice Address - Country:US
Practice Address - Phone:626-447-4442
Practice Address - Fax:626-447-2835
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14394111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0143940OtherBLUE SHIELD
CADC0143940OtherBLUE SHIELD
T1775Medicare UPIN