Provider Demographics
NPI:1578104030
Name:HENRY WELLNESS CENTER
Entity Type:Organization
Organization Name:HENRY WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-731-9921
Mailing Address - Street 1:2879 E POINT ST STE 11
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3301
Mailing Address - Country:US
Mailing Address - Phone:404-518-6825
Mailing Address - Fax:404-506-9157
Practice Address - Street 1:2879 E POINT ST STE 11
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3301
Practice Address - Country:US
Practice Address - Phone:404-518-6825
Practice Address - Fax:404-506-9157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty