Provider Demographics
NPI:1336589449
Name:HENDERSON, TWILA DE VON (DC)
Entity Type:Individual
Prefix:DR
First Name:TWILA
Middle Name:DE VON
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 CASIE CT
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-7612
Mailing Address - Country:US
Mailing Address - Phone:940-230-5220
Mailing Address - Fax:
Practice Address - Street 1:508 S ELM ST
Practice Address - Street 2:103
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-6049
Practice Address - Country:US
Practice Address - Phone:940-230-5220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12394111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1114369733Medicare PIN