Provider Demographics
NPI:1033319033
Name:HENSEL, CLYDE O JR (DC)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:O
Last Name:HENSEL
Suffix:JR
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 1:24B SOUTH CLAY ST
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654
Mailing Address - Country:US
Mailing Address - Phone:330-674-6700
Mailing Address - Fax:330-674-6339
Practice Address - Street 1:24B SOUTH CLAY ST
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654
Practice Address - Country:US
Practice Address - Phone:330-674-6700
Practice Address - Fax:330-674-6339
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1482111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U17948Medicare UPIN
HE0646593Medicare UPIN