MEDICARE: DR. LASHAWNA 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	B01546	NV
2	111N00000X	Chiropractor	29919	CA

General Provider Information

NPI Number	:	1639562036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LASHAWNA HENDERSON D.C.

Provider Business Mailing Address
First Line	:	8264 OLD CREEK RANCH ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-7207
Country	:	US
Telephone Number	:	818-294-9678
Fax Number	:

Provider Business Practice Location Address
First Line	:	3455 E LAKE MEAD BLVD
Second Line	:	STE. 1
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7329
Country	:	US
Telephone Number	:	702-642-1300
Fax Number	:

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

Provider Enumeration Date	:	03/09/2015
Last Update Date	:	03/09/2015

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