Provider Demographics
NPI:1447441746
Name:HENDERSON CHIROPRACTIC LLC
Entity type:Organization
Organization Name:HENDERSON CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:D,C
Authorized Official - Phone:330-899-1099
Mailing Address - Street 1:3593 S ARLINGTON RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-5271
Mailing Address - Country:US
Mailing Address - Phone:330-899-1099
Mailing Address - Fax:330-899-1098
Practice Address - Street 1:3593 S ARLINGTON RD
Practice Address - Street 2:SUITE F
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-5271
Practice Address - Country:US
Practice Address - Phone:330-899-1099
Practice Address - Fax:330-899-1098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2854111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty