Provider Demographics
NPI:1245578038
Name:WALLACE-HENDERSON, SEKORA DENAE (BS, DC)
Entity Type:Individual
Prefix:DR
First Name:SEKORA
Middle Name:DENAE
Last Name:WALLACE-HENDERSON
Suffix:
Gender:F
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:GAP
Mailing Address - State:PA
Mailing Address - Zip Code:17527-9609
Mailing Address - Country:US
Mailing Address - Phone:717-435-3935
Mailing Address - Fax:
Practice Address - Street 1:91 NEWPORT RD STE 302-303
Practice Address - Street 2:
Practice Address - City:GAP
Practice Address - State:PA
Practice Address - Zip Code:17527-9579
Practice Address - Country:US
Practice Address - Phone:610-979-0415
Practice Address - Fax:610-979-0438
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010562111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor