MEDICARE: DR. MICHAEL ALAN HENRIKSEN DC

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	7601	AZ

General Provider Information

NPI Number	:	1952489486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ALAN HENRIKSEN DC

Provider Business Mailing Address
First Line	:	718 E MOUNTAIN SAGE DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-4424
Country	:	US
Telephone Number	:	480-460-0664
Fax Number	:	480-460-6678

Provider Business Practice Location Address
First Line	:	1241 E CHANDLER BLVD
Second Line	:	STE 122
City	:	PHOENIX
State	:	AZ
Zip	:	85048-4605
Country	:	US
Telephone Number	:	480-460-1177
Fax Number	:	480-460-1114

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/02/2019

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