Provider Demographics
NPI:1336636463
Name:HENDRIX, DUSTIN CLINT (DC)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:CLINT
Last Name:HENDRIX
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 1:1003 LEGACY RANCH RD UNIT 206
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1294
Mailing Address - Country:US
Mailing Address - Phone:972-543-3876
Mailing Address - Fax:844-270-0782
Practice Address - Street 1:1003 LEGACY RANCH RD UNIT 206
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165
Practice Address - Country:US
Practice Address - Phone:972-543-3876
Practice Address - Fax:844-270-0782
Is Sole Proprietor?:No
Enumeration Date:2018-04-14
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor