MEDICARE: CORY E. HENDERSON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	B01457	NV

General Provider Information

NPI Number	:	1326200486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORY E. HENDERSON D.C.

Provider Business Mailing Address
First Line	:	PO BOX 36853
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-6853
Country	:	US
Telephone Number	:	702-434-2800
Fax Number	:	702-451-1034

Provider Business Practice Location Address
First Line	:	3662 E SUNSET RD
Second Line	:	SUITE #110
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-7240
Country	:	US
Telephone Number	:	817-624-7222
Fax Number	:	817-624-7233

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	01/31/2014

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