Provider Demographics
NPI:1578584777
Name:HENRY, LUCIAN (CH)
Entity Type:Individual
Prefix:
First Name:LUCIAN
Middle Name:
Last Name:HENRY
Suffix:
Gender:M
Credentials:CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 PELHAM RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3646
Mailing Address - Country:US
Mailing Address - Phone:864-288-7797
Mailing Address - Fax:864-288-4442
Practice Address - Street 1:1314 PELHAM RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3646
Practice Address - Country:US
Practice Address - Phone:864-288-7797
Practice Address - Fax:864-288-4442
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3098111N00000X
NC3451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA14738541Medicare PIN