Provider Demographics
NPI:1871660449
Name:HENRIQUES, DONALD PAUL JR (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:PAUL
Last Name:HENRIQUES
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:626 S PEACH ALY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-2578
Mailing Address - Country:US
Mailing Address - Phone:717-367-6224
Mailing Address - Fax:717-367-6580
Practice Address - Street 1:626 S PEACH ALY
Practice Address - Street 2:SUITE 102
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-2578
Practice Address - Country:US
Practice Address - Phone:717-367-6224
Practice Address - Fax:717-367-6580
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003862L111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA038216SUBMedicare ID - Type UnspecifiedINDIVIDUAL NUMBER