Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | T41720 | AZ |
NPI | 1215917554 |
---|---|
Provider Name | Monte D Hessler |
First Address | Phoenix, AZ 85004-2697 |
Second Address | Phoenix, AZ 85004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 22/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1215917554 | NPI (01) | AZ |
T41720 | (02) | AZ |