Provider Demographics
NPI:1497820955
Name:HENDERSON, DONALD TAYLOR (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:TAYLOR
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 1487
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37024-1487
Mailing Address - Country:US
Mailing Address - Phone:615-373-0276
Mailing Address - Fax:615-373-0879
Practice Address - Street 1:785 OLD HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4512
Practice Address - Country:US
Practice Address - Phone:615-371-1091
Practice Address - Fax:615-373-0879
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC355111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT74540Medicare UPIN