Provider Demographics
NPI:1083707871
Name:HENDRICKSON, LYNNETTE RENAE (DC, FICPA)
Entity Type:Individual
Prefix:DR
First Name:LYNNETTE
Middle Name:RENAE
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:DC, FICPA
Other - Prefix:DR
Other - First Name:LYNNETTE
Other - Middle Name:RENAE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC, FICPA
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
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS104365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS062001Medicare ID - Type Unspecified
KSU76840Medicare UPIN