Provider Demographics
NPI:1447318456
Name:HESS, JOHN WALTER (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WALTER
Last Name:HESS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 CONDOR AVE
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92823-1007
Mailing Address - Country:US
Mailing Address - Phone:714-921-1546
Mailing Address - Fax:714-921-2546
Practice Address - Street 1:1520 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-1928
Practice Address - Country:US
Practice Address - Phone:714-921-1546
Practice Address - Fax:714-921-2546
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU52793Medicare UPIN
CADC21619Medicare ID - Type UnspecifiedLICENSE