Provider Demographics
NPI:1679679377
Name:HENSON, LAURA E (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:E
Last Name:HENSON
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 1:777 SILVER SPUR RD
Mailing Address - Street 2:STE 232
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3644
Mailing Address - Country:US
Mailing Address - Phone:310-373-4747
Mailing Address - Fax:310-373-9225
Practice Address - Street 1:777 SILVER SPUR RD
Practice Address - Street 2:STE 232
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3644
Practice Address - Country:US
Practice Address - Phone:310-373-4747
Practice Address - Fax:310-373-9225
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0216020OtherBLUE SHIELD
CADC21602Medicare ID - Type Unspecified