Healthcare Provider Details

I. General information

NPI: 1952671315
Provider Name (Legal Business Name): CRAIG HENDERSON DC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510B SW 5TH TER
WILLISTON FL
32696-2548
US

IV. Provider business mailing address

510B SW 5TH TER
WILLISTON FL
32696-2548
US

V. Phone/Fax

Practice location:
  • Phone: 352-528-5433
  • Fax: 352-528-0656
Mailing address:
  • Phone: 352-528-5433
  • Fax: 352-528-0656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH4752
License Number StateFL

VIII. Authorized Official

Name: DR. CRAIG HENDERSON
Title or Position: PRESIDENT
Credential: D.C.
Phone: 352-528-5433