Provider Demographics
NPI:1467168880
Name:HENDRICKSON, WESLEY (DC)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:HENDRICKSON
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 1:1707 ALPINE DR STE B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3562
Mailing Address - Country:US
Mailing Address - Phone:931-548-8132
Mailing Address - Fax:931-833-7645
Practice Address - Street 1:1707 ALPINE DR STE B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3562
Practice Address - Country:US
Practice Address - Phone:931-933-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3175111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3175OtherLICENSE