Healthcare Provider Details

I. General information

NPI: 1508852450
Provider Name (Legal Business Name): DENNIS WAYNE HENSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 9TH ST SUITE C
TRENTON MO
64683-2763
US

IV. Provider business mailing address

1601 E 9TH ST SUITE C
TRENTON MO
64683-2763
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: