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General NPI Number Information
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NPI Number | 1669766283
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Entity Type | Individual
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Provider Name | CHRIS HENDERSON MD
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Gender | Male
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Dates
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Enumeration Date | 05/31/2011
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Last Update Date | 06/08/2020
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Provider Practice Location Address
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Address Line | 1380 S COLUMBIA RD
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City | GRAND FORKS
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State | ND
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Zip | 58201-4059
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Country | US
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Telephone | 701-795-2000
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Fax | 701-795-2260
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Provider Business Mailing Address
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Address Line | 725 HAMLINE ST
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City | GRAND FORKS
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State | ND
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Zip | 58203-2819
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Country | US
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Telephone | 701-795-2000
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Fax | 701-795-2260
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 12463
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License Number State | ND
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