Kevin Duane Henderson, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

025202 CHOOOO2023 Issued in WA

Practice address

2040 6TH Ave
Tacoma, WA 98403-1045

Phone

(253) 572-1881

Fax

(253) 572-5682

NPI assigned

Aug 18, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269820800000",
    "number": "1720070477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2040 6TH AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984031045",
            "telephone_number": "253-572-1881",
            "fax_number": "253-572-5682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2040 6TH AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984031045",
            "telephone_number": "253-572-1881",
            "fax_number": "253-572-5682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "KEVIN",
        "middle_name": "DUANE",
        "name_prefix": "Mr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-18",
        "last_updated": "2010-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "025202 CHOOOO2023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2028538",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMERA BLUE CROSS SHIELD",
            "identifier": "911471138",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE RIDER NUMBER",
            "identifier": "HE3793",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASH NETQORK",
            "identifier": "KH1021774",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "911471138",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "911471138",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMP",
            "identifier": "0070405",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST CHOICE HEALTH",
            "identifier": "873745",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brenda Lee Henderson-Stephenson, LPN
• Amber L. Henderson, M.D.
• Emily Elise Henderson, MB BCH BAO
• Gloria Henderson
• Hayley Marie Henderson
• Shamica Henderson
• Sophia Antoinette Henderson, MHT
• Susanne Noel Henderson, ARNP
• Onya Hendicks
• Amanda Joanne Hendricks, L.P.N.

• Chiropractor in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Chiropractor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.