Provider Demographics
NPI:1033531876
Name:HENSS, BRYAN (DC)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:HENSS
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 1:8333 SOHI DR STE 102
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-3781
Mailing Address - Country:US
Mailing Address - Phone:817-281-1400
Mailing Address - Fax:817-281-1402
Practice Address - Street 1:8333 SOHI DR STE 102
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-3781
Practice Address - Country:US
Practice Address - Phone:817-281-1400
Practice Address - Fax:817-281-1402
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12502111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor