Provider Demographics
NPI:1992867261
Name:HENDRICKSON, AARON JOHN (DC)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:JOHN
Last Name:HENDRICKSON
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 1:1200 N HWY 25
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-2930
Mailing Address - Country:US
Mailing Address - Phone:763-682-5490
Mailing Address - Fax:763-682-9459
Practice Address - Street 1:1200 N HWY 25
Practice Address - Street 2:SUITE 109
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-2930
Practice Address - Country:US
Practice Address - Phone:763-682-5490
Practice Address - Fax:763-682-9459
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U67726Medicare UPIN