Provider Demographics
NPI:1073675344
Name:HENDRICKSON CHIROPRACTIC PA
Entity Type:Organization
Organization Name:HENDRICKSON CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HENDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-682-5490
Mailing Address - Street 1:1200 N HWY 25
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-2930
Mailing Address - Country:US
Mailing Address - Phone:763-682-5490
Mailing Address - Fax:763-682-9459
Practice Address - Street 1:1200 N HWY 25
Practice Address - Street 2:SUITE 109
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-2930
Practice Address - Country:US
Practice Address - Phone:763-682-5490
Practice Address - Fax:763-682-9459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty