Provider Demographics
NPI:1518901834
Name:KESTERSON, TORRENCE BROCK (DC)
Entity type:Individual
Prefix:
First Name:TORRENCE
Middle Name:BROCK
Last Name:KESTERSON
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 1:107 S 1470 E
Mailing Address - Street 2:STE 102
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790
Mailing Address - Country:US
Mailing Address - Phone:435-652-4476
Mailing Address - Fax:435-674-2408
Practice Address - Street 1:107 S 1470 E
Practice Address - Street 2:STE 102
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-1747
Practice Address - Country:US
Practice Address - Phone:435-652-4476
Practice Address - Fax:435-674-2408
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5807590-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005579606Medicare ID - Type Unspecified
UTV05705Medicare UPIN