Provider Demographics
NPI:1356464317
Name:HENDRICKS, ZAAHIR (DC)
Entity Type:Individual
Prefix:
First Name:ZAAHIR
Middle Name:
Last Name:HENDRICKS
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 1:263 N MERCHANTS DR
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-9459
Mailing Address - Country:US
Mailing Address - Phone:630-264-6500
Mailing Address - Fax:630-264-6385
Practice Address - Street 1:263 N MERCHANTS DR
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-9459
Practice Address - Country:US
Practice Address - Phone:630-264-6500
Practice Address - Fax:630-264-6385
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-00845111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202281Medicare ID - Type Unspecified
ILU90983Medicare UPIN