Provider Demographics
NPI:1538292610
Name:HENDERSON, JOSEPH S (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
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 1:1423 POWHATAN ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1389
Mailing Address - Country:US
Mailing Address - Phone:703-739-7650
Mailing Address - Fax:703-836-2667
Practice Address - Street 1:1423 POWHATAN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1389
Practice Address - Country:US
Practice Address - Phone:703-739-7650
Practice Address - Fax:703-836-2667
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555661111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U80519Medicare UPIN
490597Medicare PIN