Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 11789 | TX |
NPI | 1003242991 |
---|---|
Provider Name | Dr. Jenna Hendrickson |
First Address | Dallas, TX 75218-1442 |
Second Address | Dallas, TX 75218-1442 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2013 |
Last Update Date | 24/09/2013 |