Provider Demographics
NPI:1982689287
Name:HENNING, KEVIN L (DC, DACNB)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:L
Last Name:HENNING
Suffix:
Gender:M
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 E WHISPERING SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:WA
Mailing Address - Zip Code:99005-9097
Mailing Address - Country:US
Mailing Address - Phone:509-464-2273
Mailing Address - Fax:509-242-1954
Practice Address - Street 1:9720 N NEVADA ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-3412
Practice Address - Country:US
Practice Address - Phone:509-464-2273
Practice Address - Fax:509-242-1954
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002228111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
T02468Medicare UPIN
WAG319200002Medicare PIN