Provider Demographics
NPI:1609122993
Name:HENADY, PHILLIP AUGUSTINE (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:AUGUSTINE
Last Name:HENADY
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 1:729 N GREEN ST
Mailing Address - Street 2:STE C
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-1281
Mailing Address - Country:US
Mailing Address - Phone:317-456-7457
Mailing Address - Fax:
Practice Address - Street 1:920 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-1814
Practice Address - Country:US
Practice Address - Phone:574-583-5811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012023039111N00000X
IN08002665A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor