Provider Demographics
NPI:1861541849
Name:HENDERSON, DOUGLAS STUART (DC)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:STUART
Last Name:HENDERSON
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 1:3909 W NEWBERRY ROAD
Mailing Address - Street 2:STE H
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607
Mailing Address - Country:US
Mailing Address - Phone:352-373-4646
Mailing Address - Fax:352-378-8487
Practice Address - Street 1:3909 W NEWBERRY ROAD
Practice Address - Street 2:SUITE H
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607
Practice Address - Country:US
Practice Address - Phone:352-373-4646
Practice Address - Fax:352-378-8487
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70417Medicare ID - Type Unspecified