Healthcare Provider Details

I. General information

NPI: 1528478336
Provider Name (Legal Business Name): MICHAEL PATRICK HENNES D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14587 GRAND AVE STE 112
BURNSVILLE MN
55306
US

IV. Provider business mailing address

14587 GRAND AVE STE 112
BURNSVILLE MN
55306-5700
US

V. Phone/Fax

Practice location:
  • Phone: 952-898-4450
  • Fax: 651-925-0543
Mailing address:
  • Phone: 952-486-8386
  • Fax: 833-514-7290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5928
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number5928
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: