Provider Demographics
NPI:1447390612
Name:HENSON, JEFFREY DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DAVID
Last Name:HENSON
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 1:1732 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3202
Mailing Address - Country:US
Mailing Address - Phone:847-266-8000
Mailing Address - Fax:847-266-8088
Practice Address - Street 1:1732 1ST ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3202
Practice Address - Country:US
Practice Address - Phone:847-266-8000
Practice Address - Fax:847-266-8088
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU-77687Medicare UPIN
IL205654Medicare ID - Type Unspecified