Provider Demographics
NPI:1477508174
Name:ESTEFAN, DAVID JOHN (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:ESTEFAN
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 1:6044 SUNNINGDALE DR
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-8962
Mailing Address - Country:US
Mailing Address - Phone:616-301-1702
Mailing Address - Fax:616-301-1708
Practice Address - Street 1:1838 BALDWIN ST.
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428
Practice Address - Country:US
Practice Address - Phone:616-301-1702
Practice Address - Fax:616-301-1708
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007774111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950G0620OtherBLUE CROSS BLUE SHIELD
MI950G0620OtherBLUE CROSS BLUE SHIELD
ON39590Medicare ID - Type Unspecified