Provider Demographics
NPI:1174676647
Name:HENRY CHIROPRACTIC CLINIC PLLC
Entity Type:Organization
Organization Name:HENRY CHIROPRACTIC CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:662-890-5454
Mailing Address - Street 1:8820 GOODMAN RD
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-2204
Mailing Address - Country:US
Mailing Address - Phone:662-890-5454
Mailing Address - Fax:662-893-8343
Practice Address - Street 1:8820 GOODMAN RD
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-2204
Practice Address - Country:US
Practice Address - Phone:662-890-5454
Practice Address - Fax:662-893-8343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS965111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1346239290OtherDR. BRIAN K HENRY NPI
6332775OtherCIGNA
MS4430072OtherUNITED HEALTHCARE
MS428516988BOtherBLUE CROSS BLUE SHIELD
6241720001OtherCIGNA MEDICARE DME
MS1174676647OtherNPI
TN4433003OtherUNITED HEALTHCARE
5455686OtherAETNA
TN4140696OtherBLUE CROSS BLUE SHIELD
MS512G700109OtherMEDICARE GRP PTAN
MS428516988BOtherBLUE CROSS BLUE SHIELD
6332775OtherCIGNA
5455686OtherAETNA
MS428516988BOtherBLUE CROSS BLUE SHIELD
MS350000331Medicare PIN
6241720001OtherCIGNA MEDICARE DME
MS6241720001Medicare NSC