Provider Demographics
NPI:1740224542
Name:HENDERSON, CHAD C (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:C
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 1:1056 S HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-2893
Mailing Address - Country:US
Mailing Address - Phone:606-679-6385
Mailing Address - Fax:606-679-5556
Practice Address - Street 1:1056 S HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-2893
Practice Address - Country:US
Practice Address - Phone:606-679-6385
Practice Address - Fax:606-679-5556
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4414111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85001154Medicaid
KY85001154Medicaid
KY6079202Medicare ID - Type Unspecified