Healthcare Provider Details

I. General information

NPI: 1114087517
Provider Name (Legal Business Name): C. GREG HENDERSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5256 S MISSION RD #406
BONSALL CA
92003-3614
US

IV. Provider business mailing address

5256 S MISSION RD #406
BONSALL CA
92003-3614
US

V. Phone/Fax

Practice location:
  • Phone: 760-728-2800
  • Fax: 760-509-1313
Mailing address:
  • Phone: 760-728-2800
  • Fax: 760-509-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC13548
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: