Provider Demographics
NPI:1992705610
Name:HENDRICKS, JOHN C (PA-C)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
Last Name:HENDRICKS
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 SHELDON BLVD SE
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503
Practice Address - Country:US
Practice Address - Phone:616-391-6120
Practice Address - Fax:616-391-6125
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2014-01-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601001665363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant