Provider Demographics
NPI:1467584201
Name:HENRIKSEN, CHAD C (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:C
Last Name:HENRIKSEN
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 1:1223 KINDER DR
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-9437
Mailing Address - Country:US
Mailing Address - Phone:952-442-7075
Mailing Address - Fax:952-442-7086
Practice Address - Street 1:124 W MAIN ST
Practice Address - Street 2:SUITE #4
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-6000
Practice Address - Country:US
Practice Address - Phone:952-442-7075
Practice Address - Fax:952-442-7086
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003337111N00000X, 111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN050M6HEOtherBLUE CROSS BLUE SHIELD MN
MN4489668Medicaid
MN4489668Medicaid