Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH 2674 | FL |
N | 111NN0400X | Neurology | CH 2674 | FL |
NPI | 1578601118 |
---|---|
Provider Name | Robert D. Henderson |
First Address | Orlando, FL 32801-2120 |
Second Address | Orlando, FL 32801-2120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2007 |
Last Update Date | 01/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T56418 | (02) | FL |