Provider Demographics
NPI:1508852450
Name:HENSON, DENNIS WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:WAYNE
Last Name:HENSON
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 1:1601 E 9TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:TRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:64683-2763
Mailing Address - Country:US
Mailing Address - Phone:660-359-5900
Mailing Address - Fax:660-359-5901
Practice Address - Street 1:1601 E 9TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:TRENTON
Practice Address - State:MO
Practice Address - Zip Code:64683-2763
Practice Address - Country:US
Practice Address - Phone:660-359-5900
Practice Address - Fax:660-359-5901
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006272111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO758555502Medicaid
MO758555502Medicaid
MOF780000Medicare ID - Type Unspecified