Provider Demographics
NPI:1356368443
Name:HENNING, HOWARD R (DC)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:R
Last Name:HENNING
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115
Mailing Address - Country:US
Mailing Address - Phone:262-728-8208
Mailing Address - Fax:262-728-9818
Practice Address - Street 1:1221 PHOENIX STREET
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115
Practice Address - Country:US
Practice Address - Phone:262-728-8208
Practice Address - Fax:262-728-9818
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1397012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38750300Medicaid
WIT62193Medicare UPIN
WI75507Medicare ID - Type Unspecified