Provider Demographics
NPI:1669520037
Name:HENDON, BRENT ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ALAN
Last Name:HENDON
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 1:1616 W NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-5254
Mailing Address - Country:US
Mailing Address - Phone:847-398-3818
Mailing Address - Fax:847-398-0138
Practice Address - Street 1:1616 W NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-5254
Practice Address - Country:US
Practice Address - Phone:847-398-3818
Practice Address - Fax:847-398-0138
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1622026OtherBLUECROSSBLUESHIELD
IL411660Medicare ID - Type Unspecified