1083707871 NPI number — DR. LYNNETTE RENAE HENDRICKSON D.C., FICPA

Table of content: DR. LYNNETTE RENAE HENDRICKSON D.C., FICPA (NPI 1083707871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083707871 NPI number — DR. LYNNETTE RENAE HENDRICKSON D.C., FICPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENDRICKSON
Provider First Name:
LYNNETTE
Provider Middle Name:
RENAE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C., FICPA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
LYNNETTE
Provider Other Middle Name:
RENAE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C., FICPA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083707871
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
508 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67114-2229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-283-6363
Provider Business Mailing Address Fax Number:
316-283-1812

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
508 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67114-2229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-283-6363
Provider Business Practice Location Address Fax Number:
316-283-1812
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  104365 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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