Provider Demographics
NPI:1346290525
Name:HESKETT, MICHAEL RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RAY
Last Name:HESKETT
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 1:310 CENTRAL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3114
Mailing Address - Country:US
Mailing Address - Phone:423-581-5519
Mailing Address - Fax:423-585-5666
Practice Address - Street 1:310 CENTRAL CHURCH RD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3114
Practice Address - Country:US
Practice Address - Phone:423-581-5519
Practice Address - Fax:423-585-5666
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3048685OtherBLUE CROSS BLUE SHIELD
TNU64558Medicare UPIN
TN3678704Medicare ID - Type Unspecified