Provider Demographics
NPI:1699730085
Name:HENDRICKSEN, REJINA (DC)
Entity type:Individual
Prefix:DR
First Name:REJINA
Middle Name:
Last Name:HENDRICKSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:REJINA
Other - Middle Name:
Other - Last Name:HABRACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6703 SHANNON PKWY
Mailing Address - Street 2:STE 14
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-2073
Mailing Address - Country:US
Mailing Address - Phone:770-964-3334
Mailing Address - Fax:770-306-2680
Practice Address - Street 1:6703 SHANNON PKWY
Practice Address - Street 2:STE 14
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-2073
Practice Address - Country:US
Practice Address - Phone:770-964-3334
Practice Address - Fax:770-306-2680
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCJNHMedicare ID - Type Unspecified
U86511Medicare UPIN