Provider Demographics
NPI:1801945548
Name:HENDERSON, WALTER E JR (DC)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:E
Last Name:HENDERSON
Suffix:JR
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 1:1097 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-2241
Mailing Address - Country:US
Mailing Address - Phone:860-828-8220
Mailing Address - Fax:860-828-8232
Practice Address - Street 1:1101 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-2241
Practice Address - Country:US
Practice Address - Phone:860-828-8220
Practice Address - Fax:860-828-8232
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001443111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT47-0862263OtherCIGNA
CT47-0862263OtherUNITED HEALTH CARE
CT47-0862263OtherAETNA
CTP2811446OtherOXFORD HEALTH
CT050001443CT01OtherBLUE CROSS BLUE SHIELD
CTU90686Medicare UPIN
CT47-0862263OtherCIGNA