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General NPI Number Information
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NPI Number | 1508475450
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Entity Type | Individual
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Provider Name | CHARMAURA D HENDERSON BS, ATC, MS, DC
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Gender | Female
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Dates
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Enumeration Date | 07/27/2020
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Last Update Date | 04/08/2024
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Provider Practice Location Address
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Address Line | 3000 CUSTER RD STE 260
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City | PLANO
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State | TX
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Zip | 75075-4427
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Country | US
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Telephone | 214-494-9553
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Fax | 214-975-5979
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Provider Business Mailing Address
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Address Line | 4421 RIDGE POINT LN
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City | PLANO
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State | TX
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Zip | 75024-7039
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Country | US
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Telephone | 314-600-1821
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT8155
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 14888
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License Number State | TX
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