Provider Demographics
NPI:1245459221
Name:JASON J. HESSELBERG DC PLLC
Entity type:Organization
Organization Name:JASON J. HESSELBERG DC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HESSELBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-677-0111
Mailing Address - Street 1:4039 CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9272
Mailing Address - Country:US
Mailing Address - Phone:734-677-0111
Mailing Address - Fax:734-677-0135
Practice Address - Street 1:4039 CARPENTER RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9272
Practice Address - Country:US
Practice Address - Phone:734-677-0111
Practice Address - Fax:734-677-0135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H114020OtherBLUE CROSS BLUE SHIELD
MI950H114020OtherBLUE CROSS BLUE SHIELD
MIU92194Medicare UPIN