Healthcare Provider Details

I. General information

NPI: 1467584201
Provider Name (Legal Business Name): CHAD C HENRIKSEN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 W MAIN ST SUITE #4
WACONIA MN
55387-6000
US

IV. Provider business mailing address

1223 KINDER DR
WACONIA MN
55387-9437
US

V. Phone/Fax

Practice location:
  • Phone: 952-442-7075
  • Fax: 952-442-7086
Mailing address:
  • Phone: 952-442-7075
  • Fax: 952-442-7086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number003337
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number003337
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: