Healthcare Provider Details

I. General information

NPI: 1033110846
Provider Name (Legal Business Name): SAMUEL BRIAN HESTER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42104 N VENTURE DR A-102
ANTHEM AZ
85086-3823
US

IV. Provider business mailing address

41930 N VENTURE DR STE 110
ANTHEM AZ
85086-3858
US

V. Phone/Fax

Practice location:
  • Phone: 623-551-9100
  • Fax: 623-551-9103
Mailing address:
  • Phone: 623-680-4496
  • Fax: 623-551-9103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6025
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: