Provider Demographics
NPI:1508969783
Name:HENDERSON, ROBERT S (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
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 1:3593 S ARLINGTON RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-5271
Mailing Address - Country:US
Mailing Address - Phone:330-899-1099
Mailing Address - Fax:330-899-1098
Practice Address - Street 1:3593 S ARLINGTON RD
Practice Address - Street 2:SUITE F
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-5271
Practice Address - Country:US
Practice Address - Phone:330-899-1099
Practice Address - Fax:330-899-1098
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2854111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000342513OtherANTHEM BLUE CROSS BLUE S
OH000000342513OtherANTHEM BLUE CROSS BLUE S