Provider Demographics
NPI:1609877034
Name:HENN, CHRISTOPHER IVAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:IVAN
Last Name:HENN
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 1:1610 E TYLER AVE STE E
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7482
Mailing Address - Country:US
Mailing Address - Phone:956-734-5111
Mailing Address - Fax:
Practice Address - Street 1:1610 E TYLER AVE STE E
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7482
Practice Address - Country:US
Practice Address - Phone:956-734-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX07100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088501402Medicaid
TXU63454Medicare UPIN
TX088501402Medicaid