Provider Demographics
NPI:1053574020
Name:HENGESTEG CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:HENGESTEG CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HENGESTEG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:858-679-8179
Mailing Address - Street 1:12439 POWAY RD
Mailing Address - Street 2:#A
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-4317
Mailing Address - Country:US
Mailing Address - Phone:858-679-8179
Mailing Address - Fax:858-679-3793
Practice Address - Street 1:12439 POWAY RD
Practice Address - Street 2:#A
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4317
Practice Address - Country:US
Practice Address - Phone:858-679-8179
Practice Address - Fax:858-679-3793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC25906AOtherLEGACY #
CA496396Medicare UPIN
CAW16518Medicare PIN