Provider Demographics
NPI:1477564037
Name:HENDERSON, DARRON LEON (DC)
Entity Type:Individual
Prefix:DR
First Name:DARRON
Middle Name:LEON
Last Name:HENDERSON
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 1785
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-1785
Mailing Address - Country:US
Mailing Address - Phone:660-438-5224
Mailing Address - Fax:660-438-9791
Practice Address - Street 1:1630 E. MAIN
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355
Practice Address - Country:US
Practice Address - Phone:660-438-5224
Practice Address - Fax:660-438-9791
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000144137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000A416Medicare ID - Type UnspecifiedMEDICARE
MO48-126-8187Medicare UPIN