Provider Demographics
NPI:1982754834
Name:HENDERSON, NANCY E (DC)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:E
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 NEWMARCH ST
Mailing Address - Street 2:
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904-1619
Mailing Address - Country:US
Mailing Address - Phone:207-439-0190
Mailing Address - Fax:
Practice Address - Street 1:8 NEWMARCH ST
Practice Address - Street 2:
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904-1619
Practice Address - Country:US
Practice Address - Phone:207-439-0190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME099229OtherANTHEM BCBS
MEMM5907Medicare ID - Type Unspecified
ME099229OtherANTHEM BCBS