Provider Demographics
NPI:1245239896
Name:HENRY, MARTHA (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 HEARTWOOD DR STE B
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-3993
Mailing Address - Country:US
Mailing Address - Phone:707-839-6300
Mailing Address - Fax:707-839-6304
Practice Address - Street 1:1585 HEARTWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-3993
Practice Address - Country:US
Practice Address - Phone:707-839-6300
Practice Address - Fax:707-839-6304
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-16
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0217830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U29726Medicare UPIN