Healthcare Provider Details

I. General information

NPI: 1508028580
Provider Name (Legal Business Name): HESTER FAMILY CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42104 N VENTURE DR E-101
PHOENIX AZ
85086-3823
US

IV. Provider business mailing address

42104 N VENTURE DR E-101
PHOENIX AZ
85086-3823
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. SAMUEL BRIAN HESTER
Title or Position: CHIROPRACTOR/OWNER
Credential: DC
Phone: 623-551-9100