Provider Demographics
NPI:1578070074
Name:HENRICHS, MICHAEL SHAWN JR (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SHAWN
Last Name:HENRICHS
Suffix:JR
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 1:210 SW 11TH ST
Mailing Address - Street 2:STE 3
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-5325
Mailing Address - Country:US
Mailing Address - Phone:515-238-6293
Mailing Address - Fax:
Practice Address - Street 1:210 SW 11TH ST
Practice Address - Street 2:STE 3
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-5325
Practice Address - Country:US
Practice Address - Phone:515-276-4344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-05
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA090328111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor