Provider Demographics
NPI:1750399408
Name:HENDERSON, ROBIN MICHELLE (DC DICCP)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:MICHELLE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:DC DICCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-4423
Mailing Address - Country:US
Mailing Address - Phone:630-837-3707
Mailing Address - Fax:630-837-3706
Practice Address - Street 1:366 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-4423
Practice Address - Country:US
Practice Address - Phone:630-837-3707
Practice Address - Fax:630-837-3706
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205031Medicaid
U94323Medicare UPIN
IL205031Medicare PIN