Provider Demographics
NPI:1518330034
Name:HENK, MARY LORAN MAKENZIE (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY LORAN
Middle Name:MAKENZIE
Last Name:HENK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MARY LORAN
Other - Middle Name:MAKENZIE
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:42560 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314
Mailing Address - Country:US
Mailing Address - Phone:586-943-0584
Mailing Address - Fax:586-745-1531
Practice Address - Street 1:42560 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314
Practice Address - Country:US
Practice Address - Phone:586-943-0584
Practice Address - Fax:586-745-1531
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015013420111N00000X
MI2301010430111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor