Provider Demographics
NPI:1922420256
Name:HENRY HEALTH & WELLNESS, LLC
Entity Type:Organization
Organization Name:HENRY HEALTH & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:662-890-5454
Mailing Address - Street 1:2620 HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-2137
Mailing Address - Country:US
Mailing Address - Phone:662-449-7534
Mailing Address - Fax:662-449-7533
Practice Address - Street 1:2620 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-2137
Practice Address - Country:US
Practice Address - Phone:662-449-7534
Practice Address - Fax:662-449-7533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS343816Medicare PIN