Provider Demographics
NPI:1841379435
Name:HENDRICKSON, DAVID PIERCE (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PIERCE
Last Name:HENDRICKSON
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 1:34108 32ND AVE E
Mailing Address - Street 2:
Mailing Address - City:EATONVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98328-8236
Mailing Address - Country:US
Mailing Address - Phone:253-847-5729
Mailing Address - Fax:
Practice Address - Street 1:5015 TACOMA MALL BLVD
Practice Address - Street 2:E 102
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7107
Practice Address - Country:US
Practice Address - Phone:253-472-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor