Provider Demographics
NPI:1891840500
Name:HENNIG, VICTOR (DC)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:HENNIG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:VICTOR
Other - Middle Name:
Other - Last Name:HENNIG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:61 RENATO CT
Mailing Address - Street 2:STE 6
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-4093
Mailing Address - Country:US
Mailing Address - Phone:650-568-0118
Mailing Address - Fax:
Practice Address - Street 1:61 RENATO CT
Practice Address - Street 2:STE 6
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-4093
Practice Address - Country:US
Practice Address - Phone:650-568-0118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15234111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology