Healthcare Provider Details

I. General information

NPI: 1154667632
Provider Name (Legal Business Name): CHAD LEROY HENDRICKSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2013
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 FLYING CLOUD DR STE 100
EDEN PRAIRIE MN
55344-3320
US

IV. Provider business mailing address

6545 FLYING CLOUD DR STE 100
EDEN PRAIRIE MN
55344-3320
US

V. Phone/Fax

Practice location:
  • Phone: 952-941-3311
  • Fax: 952-944-2004
Mailing address:
  • Phone: 952-941-3311
  • Fax: 952-944-2004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5736
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: