Healthcare Provider Details

I. General information

NPI: 1023532652
Provider Name (Legal Business Name): KRISTEN ESTERVAN HEPBURN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14810 E 42ND ST S STE 100
INDEPENDENCE MO
64055-4890
US

IV. Provider business mailing address

14810 E 42ND ST S STE 100
INDEPENDENCE MO
64055-4890
US

V. Phone/Fax

Practice location:
  • Phone: 913-308-0308
  • Fax:
Mailing address:
  • Phone: 913-308-0308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2017024867
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: