Provider Demographics
NPI:1952489486
Name:HENRIKSEN, MICHAEL ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALAN
Last Name:HENRIKSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:718 E MOUNTAIN SAGE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-4424
Mailing Address - Country:US
Mailing Address - Phone:480-460-0664
Mailing Address - Fax:480-460-6678
Practice Address - Street 1:1241 E CHANDLER BLVD
Practice Address - Street 2:STE 122
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-4605
Practice Address - Country:US
Practice Address - Phone:480-460-1177
Practice Address - Fax:480-460-1114
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor