Provider Demographics
NPI:1831196633
Name:HENDRICKS, SIDNEY DEE (DC)
Entity type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:DEE
Last Name:HENDRICKS
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:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-0304
Mailing Address - Country:US
Mailing Address - Phone:801-451-7900
Mailing Address - Fax:801-451-7211
Practice Address - Street 1:352 S 200 W
Practice Address - Street 2:SUITE 2
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2423
Practice Address - Country:US
Practice Address - Phone:801-451-7900
Practice Address - Fax:801-451-7211
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
UT87175465111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor