Provider Demographics
NPI:1629516737
Name:HENRY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:HENRY CHIROPRACTIC CENTER
Other - Org Name:HENRY CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MALACHI
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-375-4091
Mailing Address - Street 1:2790 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-2249
Mailing Address - Country:US
Mailing Address - Phone:812-375-4091
Mailing Address - Fax:
Practice Address - Street 1:2790 BRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-2249
Practice Address - Country:US
Practice Address - Phone:812-375-4091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002963A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty