Provider Demographics
NPI:1336260546
Name:HENDRICKSON CHIROPRACTIC OFFICE S.C.
Entity Type:Organization
Organization Name:HENDRICKSON CHIROPRACTIC OFFICE S.C.
Other - Org Name:HENDRICKSON CHIROPRACTIC & WELLNESS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:F
Authorized Official - Last Name:HENDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-236-1200
Mailing Address - Street 1:1026 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-6457
Mailing Address - Country:US
Mailing Address - Phone:920-236-1200
Mailing Address - Fax:877-440-6236
Practice Address - Street 1:1026 OREGON ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-6457
Practice Address - Country:US
Practice Address - Phone:920-236-1200
Practice Address - Fax:877-440-6236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000075038Medicare PIN