Provider Demographics
NPI:1033208244
Name:HENRY, JOHN RAYMOND (DC DACBR)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RAYMOND
Last Name:HENRY
Suffix:
Gender:M
Credentials:DC DACBR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 NORFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1200
Mailing Address - Country:US
Mailing Address - Phone:508-238-0600
Mailing Address - Fax:508-238-0786
Practice Address - Street 1:5 NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-1200
Practice Address - Country:US
Practice Address - Phone:508-238-0600
Practice Address - Fax:508-238-0786
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH2416111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAU78594Medicare UPIN
MAY45291Medicare ID - Type Unspecified