Healthcare Provider Details

I. General information

NPI: 1356380703
Provider Name (Legal Business Name): HENSON CHIROPRACTIC CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 E 17TH ST STE C
TRENTON MO
64683-1929
US

IV. Provider business mailing address

1125 E 17TH ST STE C
TRENTON MO
64683-1929
US

V. Phone/Fax

Practice location:
  • Phone: 660-359-5900
  • Fax: 660-356-5901
Mailing address:
  • Phone: 660-359-5900
  • Fax: 660-356-5901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006272
License Number StateMO

VIII. Authorized Official

Name: DR. DENNIS WAYNE HENSON
Title or Position: PRESIDENT/PHYSICIAN
Credential: D.C.
Phone: 660-359-5900