Provider Demographics
NPI:1013964543
Name:HENDRICK CHIROPRACTIC AND WELLNESS CENTER, P.A.
Entity Type:Organization
Organization Name:HENDRICK CHIROPRACTIC AND WELLNESS CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAINE
Authorized Official - Middle Name:LOREN
Authorized Official - Last Name:HENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:956-630-2255
Mailing Address - Street 1:5403 N. MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504
Mailing Address - Country:US
Mailing Address - Phone:956-630-2255
Mailing Address - Fax:
Practice Address - Street 1:5403 N MCCOLL RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2206
Practice Address - Country:US
Practice Address - Phone:956-630-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10328111N00000X
TX10329111N00000X
TX796415363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDF4188OtherMEDICARE RAILROAD
TX0002PCOtherBCBS
TX00W732Medicare PIN