Healthcare Provider Details

I. General information

NPI: 1659377273
Provider Name (Legal Business Name): WILLIAM ERIC HESTRUP D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 TYLER RD SUITE A
SAINT CHARLES IL
60174-3305
US

IV. Provider business mailing address

525 TYLER RD SUITE A
SAINT CHARLES IL
60174-3305
US

V. Phone/Fax

Practice location:
  • Phone: 630-377-3202
  • Fax: 630-443-3209
Mailing address:
  • Phone: 630-377-3202
  • Fax: 630-443-3209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-004354
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: