Provider Demographics
NPI:1023147188
Name:HENDERSON, TROY R (DC)
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:R
Last Name:HENDERSON
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 1:8304 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-5700
Mailing Address - Country:US
Mailing Address - Phone:410-665-0000
Mailing Address - Fax:
Practice Address - Street 1:8304 HARFORD RD
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-5700
Practice Address - Country:US
Practice Address - Phone:410-665-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD 01671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD532540-01OtherBLUCE CROSS
MDT 324-00001OtherFED PROVIDER NUMBER
MDT 324-0001OtherBLUE CHOICE NUMBER
MDT 324-00001OtherFED PROVIDER NUMBER
MDM125Medicare ID - Type UnspecifiedMEDICARE