MEDICARE: DR. WILLIAM ERIC HESTRUP D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	038-004354	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	350023884	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4293603	OTHER	IL	AETNA
2	10639362	OTHER		CAQH CREDENTIALING
3	130694	OTHER		ACN GROUP
4	3329275002	OTHER	IL	CIGNA HEALTHCARE
6	4582044	OTHER	IL	BLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number	:	1659377273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM ERIC HESTRUP D.C.

Provider Business Mailing Address
First Line	:	525 TYLER RD
Second Line	:	SUITE A
City	:	SAINT CHARLES
State	:	IL
Zip	:	60174-3305
Country	:	US
Telephone Number	:	630-377-3202
Fax Number	:	630-443-3209

Provider Business Practice Location Address
First Line	:	525 TYLER RD
Second Line	:	SUITE A
City	:	SAINT CHARLES
State	:	IL
Zip	:	60174-3305
Country	:	US
Telephone Number	:	630-377-3202
Fax Number	:	630-443-3209

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	03/16/2010

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Directions to “ DR. WILLIAM ERIC HESTRUP D.C.” Practice Location

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