Provider Demographics
NPI:1255441218
Name:HENDERIKS, ERICK WALDEMAR (CHIROPRACTOR DC)
Entity type:Individual
Prefix:DR
First Name:ERICK
Middle Name:WALDEMAR
Last Name:HENDERIKS
Suffix:
Gender:M
Credentials:CHIROPRACTOR DC
Other - Prefix:
Other - First Name:ERICK
Other - Middle Name:W
Other - Last Name:HENDERIKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 7425
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-7425
Mailing Address - Country:US
Mailing Address - Phone:732-530-7711
Mailing Address - Fax:732-530-9708
Practice Address - Street 1:740 BROAD ST
Practice Address - Street 2:HWY 35 S
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702
Practice Address - Country:US
Practice Address - Phone:732-530-7711
Practice Address - Fax:732-530-9708
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC3021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1526308Medicaid
NJ1526308Medicaid
NJHE603077CQXMedicare ID - Type Unspecified