Provider Demographics
NPI:1871686477
Name:CHESTER, JEFFREY H (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:H
Last Name:CHESTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1063 LOWER MAIN ST STE C212
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-6006
Mailing Address - Country:US
Mailing Address - Phone:808-249-8887
Mailing Address - Fax:808-249-8889
Practice Address - Street 1:1063 LOWER MAIN ST STE C212
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-6006
Practice Address - Country:US
Practice Address - Phone:808-249-8887
Practice Address - Fax:808-249-8889
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS925208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
181847500OtherOWCP DOL NUMBER
HI0023228OtherHMSA PROVIDER ID NUMBER
75-2992323OtherFEDERAL ID NUMBER
181847500OtherOWCP DOL NUMBER
54168Medicare ID - Type UnspecifiedMEDICARE ID