Provider Demographics
NPI:1306095161
Name:SIDNEY D HENDRICKS D.C. INC
Entity type:Organization
Organization Name:SIDNEY D HENDRICKS D.C. INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-451-7900
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-0304
Mailing Address - Country:US
Mailing Address - Phone:801-451-7900
Mailing Address - Fax:801-451-7211
Practice Address - Street 1:352 S 200 W
Practice Address - Street 2:SUITE 2
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2423
Practice Address - Country:US
Practice Address - Phone:801-451-7900
Practice Address - Fax:801-451-7211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT870451872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000005860Medicare PIN