=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356380703
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HENSON CHIROPRACTIC CLINIC PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2006
-----------------------------------------------------
Last Update Date | 10/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1125 E 17TH ST STE C
-----------------------------------------------------
City | TRENTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64683-1929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-359-5900
-----------------------------------------------------
Fax | 660-356-5901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1125 E 17TH ST STE C
-----------------------------------------------------
City | TRENTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64683-1929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-359-5900
-----------------------------------------------------
Fax | 660-356-5901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PHYSICIAN
-----------------------------------------------------
Name | DR. DENNIS WAYNE HENSON
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 660-359-5900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 006272
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------