Provider Demographics
NPI:1679563969
Name:HENDERSON, TIMOTHY D (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:D
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1163
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76241-1163
Mailing Address - Country:US
Mailing Address - Phone:940-902-3979
Mailing Address - Fax:214-292-9650
Practice Address - Street 1:1019 E CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-4203
Practice Address - Country:US
Practice Address - Phone:940-902-3979
Practice Address - Fax:214-292-9650
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
TX8356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171400000XOther Service ProvidersHealth & Wellness Coach
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145707902Medicaid
TXU73641Medicare UPIN
TX609314Medicare ID - Type Unspecified