Provider Demographics
NPI:1215004734
Name:HENDERSON, STEVEN EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:EDWARD
Last Name:HENDERSON
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 1:3615 FISHINGER BLVD.
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7559
Mailing Address - Country:US
Mailing Address - Phone:614-767-1000
Mailing Address - Fax:614-767-1002
Practice Address - Street 1:3615 FISHINGER BLVD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-2255
Practice Address - Country:US
Practice Address - Phone:614-767-1000
Practice Address - Fax:614-767-1002
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1052111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4594127OtherAETNA
OH000000341527OtherANTHEM BLUE CROSS AND BLU
OH0173977Medicaid
U20577Medicare UPIN