Provider Demographics
NPI:1326200486
Name:HENDERSON, CORY E (DC)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:E
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:PO BOX 36853
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-6853
Mailing Address - Country:US
Mailing Address - Phone:702-434-2800
Mailing Address - Fax:702-451-1034
Practice Address - Street 1:3662 E SUNSET RD
Practice Address - Street 2:SUITE #110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-7240
Practice Address - Country:US
Practice Address - Phone:817-624-7222
Practice Address - Fax:817-624-7233
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01457111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor