1417979659 NPI number — MR. MARTIN REGINALD HENSCHELL D.C.

Table of content: MR. MARTIN REGINALD HENSCHELL D.C. (NPI 1417979659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417979659 NPI number — MR. MARTIN REGINALD HENSCHELL D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENSCHELL
Provider First Name:
MARTIN
Provider Middle Name:
REGINALD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HENSCHELL
Provider Other First Name:
MARTIN
Provider Other Middle Name:
REGINALD
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1417979659
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20119 S PRAIRIE RD E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BONNEY LAKE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98391-7935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-862-1555
Provider Business Mailing Address Fax Number:
253-862-1557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20119 S PRAIRIE RD E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BONNEY LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98391-7935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-862-1555
Provider Business Practice Location Address Fax Number:
253-862-1557
Provider Enumeration Date:
07/24/2006

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:  CH00033603 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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