Provider Demographics
NPI:1861894057
Name:HENSON, MICHAEL LEE (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEE
Last Name:HENSON
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 363
Mailing Address - Street 2:
Mailing Address - City:POTOSI
Mailing Address - State:MO
Mailing Address - Zip Code:63664-0363
Mailing Address - Country:US
Mailing Address - Phone:573-438-2200
Mailing Address - Fax:573-436-1711
Practice Address - Street 1:10071 CRESCENT RD
Practice Address - Street 2:
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664-2040
Practice Address - Country:US
Practice Address - Phone:573-438-2200
Practice Address - Fax:573-436-1711
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014032165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor