Provider Demographics
NPI:1780057091
Name:HENSON, JUSTIN TRAVIS (DC, ATC, LAT, LMT)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:TRAVIS
Last Name:HENSON
Suffix:
Gender:M
Credentials:DC, ATC, LAT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 182
Mailing Address - Street 2:911 ATLANTIC AVENUE
Mailing Address - City:BOLING
Mailing Address - State:TX
Mailing Address - Zip Code:77420-0182
Mailing Address - Country:US
Mailing Address - Phone:979-257-6183
Mailing Address - Fax:
Practice Address - Street 1:4130 FM 762 RD STE 300
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77469-6436
Practice Address - Country:US
Practice Address - Phone:281-324-8292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT63522255A2300X
TX14629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer