Provider Demographics
NPI:1295829174
Name:LESTER, MICHELLE J (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:J
Last Name:LESTER
Suffix:
Gender:F
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:PO BOX 60506
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-0506
Mailing Address - Country:US
Mailing Address - Phone:718-605-1332
Mailing Address - Fax:718-605-1328
Practice Address - Street 1:1247 SUFFOLK AVE STE 4
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4518
Practice Address - Country:US
Practice Address - Phone:631-434-7544
Practice Address - Fax:631-434-7669
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYDC X006974-2111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX97302Medicare ID - Type Unspecified