Provider Demographics
NPI:1275619819
Name:HENRY, PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
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 1:1103 N POINT BLVD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-3469
Mailing Address - Country:US
Mailing Address - Phone:410-285-2600
Mailing Address - Fax:410-285-4942
Practice Address - Street 1:1103 N POINT BLVD
Practice Address - Street 2:SUITE 404
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-3469
Practice Address - Country:US
Practice Address - Phone:410-285-2600
Practice Address - Fax:410-285-4942
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1638111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE6610001OtherCAREFIRST
4640851OtherAETNA
MDKCF3OtherCAREFIRST BCBS
MDE6610001OtherCAREFIRST
MDM072Medicare PIN