Provider Demographics
NPI:1104919984
Name:HENDRICKSON, TODD EUGENE (DC)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:EUGENE
Last Name:HENDRICKSON
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 1:508 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-2229
Mailing Address - Country:US
Mailing Address - Phone:316-283-6363
Mailing Address - Fax:316-283-1812
Practice Address - Street 1:508 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-2229
Practice Address - Country:US
Practice Address - Phone:316-283-6363
Practice Address - Fax:316-283-1812
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS104483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU69535Medicare UPIN
KS062002Medicare ID - Type Unspecified