Provider Demographics
NPI:1891722567
Name:HENDERSON, ALVIN ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:ALLEN
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 1:1115 MCCREIGHT ST
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-3241
Mailing Address - Country:US
Mailing Address - Phone:318-281-2992
Mailing Address - Fax:318-281-2994
Practice Address - Street 1:1115 MCCREIGHT ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-3241
Practice Address - Country:US
Practice Address - Phone:318-281-2992
Practice Address - Fax:318-281-2994
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1147111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG0344OtherBLUE CROSS BLUE SHILED
LA4A871Medicare ID - Type Unspecified