Provider Demographics
NPI:1922638303
Name:HENLEY, ARWAKEE
Entity Type:Individual
Prefix:
First Name:ARWAKEE
Middle Name:
Last Name:HENLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 LYNN LN STE 1
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-9269
Mailing Address - Country:US
Mailing Address - Phone:662-546-4400
Mailing Address - Fax:
Practice Address - Street 1:46 LYNN LN STE 1
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-9269
Practice Address - Country:US
Practice Address - Phone:662-546-4400
Practice Address - Fax:662-268-4634
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor