Provider Demographics
NPI:1033253893
Name:HENDRICKSON CHIROPRACTIC & HEALTH CENTER P A
Entity Type:Organization
Organization Name:HENDRICKSON CHIROPRACTIC & HEALTH CENTER P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNNETTE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HENDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-283-6363
Mailing Address - Street 1:508 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-2229
Mailing Address - Country:US
Mailing Address - Phone:316-283-6363
Mailing Address - Fax:316-283-1812
Practice Address - Street 1:508 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-2229
Practice Address - Country:US
Practice Address - Phone:316-283-6363
Practice Address - Fax:316-283-1812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS660048Medicare ID - Type Unspecified