Provider Demographics
NPI:1710982012
Name:HENEY, STEPHEN PATRICK (DC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PATRICK
Last Name:HENEY
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 1:46 COLUMBIA RD
Mailing Address - Street 2:UNIT 8
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-1862
Mailing Address - Country:US
Mailing Address - Phone:781-826-8500
Mailing Address - Fax:781-826-8585
Practice Address - Street 1:46 COLUMBIA RD
Practice Address - Street 2:UNIT 8
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-1862
Practice Address - Country:US
Practice Address - Phone:781-826-8500
Practice Address - Fax:781-826-8585
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAU32589Medicare UPIN
MAY36200Medicare ID - Type Unspecified