Provider Demographics
NPI:1508028580
Name:HESTER FAMILY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:HESTER FAMILY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-551-9100
Mailing Address - Street 1:42104 N VENTURE DR
Mailing Address - Street 2:E-101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3823
Mailing Address - Country:US
Mailing Address - Phone:623-551-9100
Mailing Address - Fax:
Practice Address - Street 1:42104 N VENTURE DR
Practice Address - Street 2:E-101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85086-3823
Practice Address - Country:US
Practice Address - Phone:623-551-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ80746Medicare PIN