Provider Demographics
NPI:1811049398
Name:HENDERSON, STEVEN MARK (DC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:MARK
Last Name:HENDERSON
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 1:3520 WENTWORTH ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4358
Mailing Address - Country:US
Mailing Address - Phone:907-276-3720
Mailing Address - Fax:907-274-2220
Practice Address - Street 1:213 E FIREWEED LN
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2025
Practice Address - Country:US
Practice Address - Phone:907-274-2225
Practice Address - Fax:907-274-2220
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCHI 223111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH1223Medicaid
AKT95373Medicare UPIN
AKK0000QGFLCMedicare ID - Type Unspecified