Provider Demographics
NPI:1376690701
Name:HESSELBERG, JASON JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:JOSEPH
Last Name:HESSELBERG
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 1:2900 PACKARD RD STE 2
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2061
Mailing Address - Country:US
Mailing Address - Phone:734-677-0111
Mailing Address - Fax:734-677-0135
Practice Address - Street 1:2900 PACKARD RD STE 2
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2061
Practice Address - Country:US
Practice Address - Phone:734-677-0111
Practice Address - Fax:734-677-0135
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU92194Medicare UPIN
MI0N55790Medicare ID - Type Unspecified