MEDICARE: DR. STANLEY PETER HENDERSON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC13794	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WDC13794A	OTHER	CA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DC013794	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1811924905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STANLEY PETER HENDERSON D.C.

Provider Business Mailing Address
First Line	:	25050 PEACHLAND AVE
Second Line	:	SUITE 155
City	:	NEWHALL
State	:	CA
Zip	:	91321-2523
Country	:	US
Telephone Number	:	661-254-2090
Fax Number	:

Provider Business Practice Location Address
First Line	:	25050 PEACHLAND AVE
Second Line	:	SUITE 155
City	:	NEWHALL
State	:	CA
Zip	:	91321-2523
Country	:	US
Telephone Number	:	661-254-2090
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	05/22/2009

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