Provider Demographics
NPI:1750330445
Name:HENDRICK, BLAINE LOREN (DC, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:BLAINE
Middle Name:LOREN
Last Name:HENDRICK
Suffix:
Gender:M
Credentials:DC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5403 N MCCOLL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2206
Mailing Address - Country:US
Mailing Address - Phone:956-630-2255
Mailing Address - Fax:956-630-5228
Practice Address - Street 1:5403 N MCCOLL RD
Practice Address - Street 2:SUITE A
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2206
Practice Address - Country:US
Practice Address - Phone:956-630-2255
Practice Address - Fax:956-630-5228
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10328111N00000X
TX796415363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00413186OtherMEDICARE RAILROAD
TX8W8690OtherBCBS
TX8W8690OtherBCBS
TXP00413186OtherMEDICARE RAILROAD
8F3341Medicare PIN