Provider Demographics
NPI:1154556074
Name:HENDERSON, DUSTIN TODD (DC)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:TODD
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 1:24911 KUYKENDAHL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-3295
Mailing Address - Country:US
Mailing Address - Phone:281-516-1138
Mailing Address - Fax:281-516-1183
Practice Address - Street 1:24911 KUYKENDAHL RD
Practice Address - Street 2:SUITE B
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-3295
Practice Address - Country:US
Practice Address - Phone:281-516-1138
Practice Address - Fax:281-516-1183
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10781111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor