Provider Demographics
NPI:1750788139
Name:HERNDON, DEANDRA NICOLE (DC)
Entity type:Individual
Prefix:DR
First Name:DEANDRA
Middle Name:NICOLE
Last Name:HERNDON
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 1:179 HANCOCK ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-6346
Mailing Address - Country:US
Mailing Address - Phone:615-527-7960
Mailing Address - Fax:615-527-7961
Practice Address - Street 1:179 HANCOCK ST
Practice Address - Street 2:SUITE 200
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-6346
Practice Address - Country:US
Practice Address - Phone:615-527-7960
Practice Address - Fax:615-527-7961
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor