Provider Demographics
NPI:1396894168
Name:HENNING, KEITH W (DC)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:W
Last Name:HENNING
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 WOODRING ST
Mailing Address - Street 2:
Mailing Address - City:CASHMERE
Mailing Address - State:WA
Mailing Address - Zip Code:98815-1035
Mailing Address - Country:US
Mailing Address - Phone:509-782-2050
Mailing Address - Fax:509-782-2850
Practice Address - Street 1:207 WOODRING ST
Practice Address - Street 2:
Practice Address - City:CASHMERE
Practice Address - State:WA
Practice Address - Zip Code:98815-1035
Practice Address - Country:US
Practice Address - Phone:509-782-2050
Practice Address - Fax:509-782-2850
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2019149Medicaid
WA0074038OtherLABOR & INDUSTRIES
91-1506092OtherEIN
WA2019149Medicaid
WAG000315121Medicare PIN