Provider Demographics
NPI:1235995721
Name:HENDERSON, DEVIN NICOLE (DC)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:NICOLE
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 1:707 W CENTER ST UNIT 238
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65742-5810
Mailing Address - Country:US
Mailing Address - Phone:573-873-4661
Mailing Address - Fax:
Practice Address - Street 1:3250 E BATTLEFIELD RD STE P
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4081
Practice Address - Country:US
Practice Address - Phone:417-891-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024006901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor