Provider Demographics
NPI:1467696161
Name:HENNIE, CRAIG A (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
Last Name:HENNIE
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:PO BOX 10365
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37939-0365
Mailing Address - Country:US
Mailing Address - Phone:865-679-2225
Mailing Address - Fax:865-588-8799
Practice Address - Street 1:5103 KINGSTON PIKE STE 116
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5193
Practice Address - Country:US
Practice Address - Phone:865-679-2225
Practice Address - Fax:865-588-8799
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001884111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor