Provider Demographics
NPI:1669695573
Name:HESSTON CHIROPRACTIC CLINIC INC
Entity type:Organization
Organization Name:HESSTON CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MERLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:NICKELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-327-2244
Mailing Address - Street 1:359 N OLD US HIGHWAY 81
Mailing Address - Street 2:PO BOX 246
Mailing Address - City:HESSTON
Mailing Address - State:KS
Mailing Address - Zip Code:67062-9406
Mailing Address - Country:US
Mailing Address - Phone:620-327-2244
Mailing Address - Fax:620-327-5157
Practice Address - Street 1:359 N OLD US HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:HESSTON
Practice Address - State:KS
Practice Address - Zip Code:67062-9406
Practice Address - Country:US
Practice Address - Phone:620-327-2244
Practice Address - Fax:620-327-5157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03589111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty