Healthcare Provider Details

I. General information

NPI: 1205137312
Provider Name (Legal Business Name): HAYDEN HENNINGSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2206 QUEEN ANNE AVE N STE 201
SEATTLE WA
98109-2370
US

IV. Provider business mailing address

37 FOX ST
DENVER CO
80223-1519
US

V. Phone/Fax

Practice location:
  • Phone: 720-334-8544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60191706
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: