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General NPI Number Information
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NPI Number | 1255585592
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Entity Type | Organization
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Legal Business Name | HENDERSON CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 11/13/2008
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Last Update Date | 11/13/2008
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Provider Practice Location Address
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Address Line | 434 S GREEN ST
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City | HENDERSON
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State | KY
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Zip | 42420-3517
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Country | US
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Telephone | 270-831-2790
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Fax |
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Provider Business Mailing Address
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Address Line | 434 S GREEN ST
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City | HENDERSON
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State | KY
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Zip | 42420-3517
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK ALLEN
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Credential |
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Telephone | 270-831-2790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4215
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License Number State | KY
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