Provider Demographics
NPI:1932383684
Name:HENDRICKSON, RAYMOND T (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:T
Last Name:HENDRICKSON
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 1:10196 - 48 STREET
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55319
Mailing Address - Country:US
Mailing Address - Phone:320-743-3462
Mailing Address - Fax:
Practice Address - Street 1:10196 - 48 STREET
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55319
Practice Address - Country:US
Practice Address - Phone:320-743-3462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2084111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor