Provider Demographics
NPI:1083883383
Name:HENDERSON, ROSE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:MARIE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 GRAND XING
Mailing Address - Street 2:
Mailing Address - City:MOBRIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57601-2046
Mailing Address - Country:US
Mailing Address - Phone:605-845-5454
Mailing Address - Fax:605-845-5808
Practice Address - Street 1:404 GRAND XING
Practice Address - Street 2:
Practice Address - City:MOBRIDGE
Practice Address - State:SD
Practice Address - Zip Code:57601-2046
Practice Address - Country:US
Practice Address - Phone:605-845-5454
Practice Address - Fax:605-845-5808
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor