Provider Demographics
NPI:1518628601
Name:HENDERSON, JOSHUA L (DC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:L
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JOSHUA
Other - Middle Name:L
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:220 13TH ST S
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:MN
Mailing Address - Zip Code:56215-1858
Mailing Address - Country:US
Mailing Address - Phone:320-314-2368
Mailing Address - Fax:
Practice Address - Street 1:220 13TH ST S
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:MN
Practice Address - Zip Code:56215-1858
Practice Address - Country:US
Practice Address - Phone:320-314-2368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-01
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6931111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor