Provider Demographics
NPI:1538131057
Name:HENRICKSON, HEIDI (DC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:HENRICKSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 TRADE CENTER
Mailing Address - Street 2:SUITE 4460
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801
Mailing Address - Country:US
Mailing Address - Phone:781-933-5051
Mailing Address - Fax:781-756-4791
Practice Address - Street 1:300 TRADE CENTER
Practice Address - Street 2:SUITE 300
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801
Practice Address - Country:US
Practice Address - Phone:781-933-5051
Practice Address - Fax:781-756-4791
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAL-309679174N00000X
MA2341111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY45348Medicare ID - Type Unspecified
MAU80432Medicare UPIN