Provider Demographics
NPI:1326093196
Name:JESTER, DERON LOUIS (DC)
Entity Type:Individual
Prefix:
First Name:DERON
Middle Name:LOUIS
Last Name:JESTER
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 1:620 W STRASBURG RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-1955
Mailing Address - Country:US
Mailing Address - Phone:610-696-6676
Mailing Address - Fax:
Practice Address - Street 1:620 W STRASBURG RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-1955
Practice Address - Country:US
Practice Address - Phone:610-696-6676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADCDC009208L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
001620186OtherHIGHMARK
2316426000OtherIBC
001620186OtherHIGHMARK
2316426000OtherIBC