Provider Demographics
NPI:1902008246
Name:HENZE, MICHAEL T (DC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:T
Last Name:HENZE
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 1:9211 W OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-2502
Mailing Address - Country:US
Mailing Address - Phone:208-377-7970
Mailing Address - Fax:208-377-0796
Practice Address - Street 1:9211 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-2502
Practice Address - Country:US
Practice Address - Phone:208-377-7970
Practice Address - Fax:208-377-0796
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor