Provider Demographics
NPI:1356380703
Name:HENSON CHIROPRACTIC CLINIC PA
Entity type:Organization
Organization Name:HENSON CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:660-359-5900
Mailing Address - Street 1:1125 E 17TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:64683-1929
Mailing Address - Country:US
Mailing Address - Phone:660-359-5900
Mailing Address - Fax:660-356-5901
Practice Address - Street 1:1125 E 17TH ST STE C
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MO
Practice Address - Zip Code:64683-1929
Practice Address - Country:US
Practice Address - Phone:660-359-5900
Practice Address - Fax:660-356-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006272111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO30003010600OtherCOMMUNITY HEALTH
MO29495011OtherBCBS OF KC
MO758555502Medicaid
MOU53222Medicare UPIN
MO29495011OtherBCBS OF KC
KSU53222Medicare UPIN
MOU53221Medicare UPIN