Provider Demographics
NPI:1811924905
Name:HENDERSON, STANLEY PETER (DC)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:PETER
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 1:25050 PEACHLAND AVE
Mailing Address - Street 2:SUITE 155
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2523
Mailing Address - Country:US
Mailing Address - Phone:661-254-2090
Mailing Address - Fax:
Practice Address - Street 1:25050 PEACHLAND AVE
Practice Address - Street 2:SUITE 155
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2523
Practice Address - Country:US
Practice Address - Phone:661-254-2090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC13794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC13794AOtherMEDICARE PTAN
CADC013794OtherBLUE SHIELD
CAWDC13794AOtherMEDICARE PTAN