Healthcare Provider Details

I. General information

NPI: 1710814389
Provider Name (Legal Business Name): TONI HENDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11694 SEWARD HWY STE C
SEWARD AK
99664-9710
US

IV. Provider business mailing address

PO BOX 1087
SEWARD AK
99664-1087
US

V. Phone/Fax

Practice location:
  • Phone: 907-224-8680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number251867
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: