Provider Demographics
NPI:1437644036
Name:HENNEN CHIROPRACTIC NEUROLOGY AND WELLNESS
Entity Type:Organization
Organization Name:HENNEN CHIROPRACTIC NEUROLOGY AND WELLNESS
Other - Org Name:HENNEN CHIROPRACTIC NEUROLOGY AND WELLNESS
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:HENNEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:415-503-7935
Mailing Address - Street 1:1123 N EDGEFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-3624
Mailing Address - Country:US
Mailing Address - Phone:415-503-7935
Mailing Address - Fax:
Practice Address - Street 1:4105 W SPRING CREEK PKWY STE 510
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-5294
Practice Address - Country:US
Practice Address - Phone:972-599-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-26
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13849261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center