Provider Demographics
NPI:1255348769
Name:HENDERSON, CHRISTOPHER (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 BEARD RD STE 3
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3466
Mailing Address - Country:US
Mailing Address - Phone:707-942-1250
Mailing Address - Fax:707-307-0684
Practice Address - Street 1:3260 BEARD RD STE 3
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3466
Practice Address - Country:US
Practice Address - Phone:707-942-1250
Practice Address - Fax:707-307-0684
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6953171100000X
CAND65175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020659468OtherFEDERAL TAX ID