Provider Demographics
NPI:1588744155
Name:HENDERSON, KERRI LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:KERRI
Middle Name:LYNN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KERRI
Other - Middle Name:LYNN
Other - Last Name:BUTTERIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:405 2ND ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MN
Mailing Address - Zip Code:56143-1641
Mailing Address - Country:US
Mailing Address - Phone:507-478-2112
Mailing Address - Fax:507-847-3545
Practice Address - Street 1:405 2ND ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MN
Practice Address - Zip Code:56143-1641
Practice Address - Country:US
Practice Address - Phone:507-847-2112
Practice Address - Fax:507-847-3545
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3562111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU71295Medicare UPIN
MN350001759Medicare ID - Type Unspecified