Healthcare Provider Details

I. General information

NPI: 1922481860
Provider Name (Legal Business Name): CHRISTIAN HENDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W MARKET ST
AKRON OH
44303-1411
US

IV. Provider business mailing address

807 E WASHINGTON ST STE 150
MEDINA OH
44256-3339
US

V. Phone/Fax

Practice location:
  • Phone: 330-564-4639
  • Fax:
Mailing address:
  • Phone: 330-241-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: