Provider Demographics
NPI:1952671315
Name:CRAIG HENDERSON DC PA
Entity Type:Organization
Organization Name:CRAIG HENDERSON DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-528-5433
Mailing Address - Street 1:510B SW 5TH TER
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32696-2548
Mailing Address - Country:US
Mailing Address - Phone:352-528-5433
Mailing Address - Fax:352-528-0656
Practice Address - Street 1:510B SW 5TH TER
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-2548
Practice Address - Country:US
Practice Address - Phone:352-528-5433
Practice Address - Fax:352-528-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70645Medicare PIN
FLT84497Medicare UPIN