Individual
MR. KEVIN DUANE HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
2040 6TH AVE, TACOMA, WA 98403-1045
(253) 572-1881
(253) 572-5682
Mailing address
2040 6TH AVE, TACOMA, WA 98403-1045
(253) 572-1881
(253) 572-5682
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
025202 CHOOOO2023
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0070405
WORKERS COMP
WA
05
—
2028538
—
WA
01
—
873745
FIRST CHOICE HEALTH
WA
01
—
911471138
PREMERA BLUE CROSS SHIELD
WA
01
—
HE3793
REGENCE RIDER NUMBER
WA
01
—
KH1021774
ASH NETQORK
WA
Enumeration date
08/18/2005
Last updated
03/29/2010
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