Provider Demographics
NPI:1134122013
Name:HENRY, TIMOTHY J (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:HENRY
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 1:7274 RHEA COUNTY HWY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-6205
Mailing Address - Country:US
Mailing Address - Phone:423-775-0192
Mailing Address - Fax:423-775-5538
Practice Address - Street 1:7274 RHEA COUNTY HWY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-6205
Practice Address - Country:US
Practice Address - Phone:423-775-0192
Practice Address - Fax:423-775-5538
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000448111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN000056270OtherBLUE CROSS BLUE SHIELD
TN1508239Medicaid
TN36737261Medicaid
TN000056270OtherBLUE CROSS BLUE SHIELD
TN36737261Medicare PIN
TN1508239Medicaid