Healthcare Provider Details

I. General information

NPI: 1497820955
Provider Name (Legal Business Name): DONALD TAYLOR HENDERSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 OLD HICKORY BLVD
BRENTWOOD TN
37027-4512
US

IV. Provider business mailing address

PO BOX 1487
BRENTWOOD TN
37024-1487
US

V. Phone/Fax

Practice location:
  • Phone: 615-371-1091
  • Fax: 615-373-0879
Mailing address:
  • Phone: 615-373-0276
  • Fax: 615-373-0879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC355
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: