Provider Demographics
NPI:1942379599
Name:HENRY, STEPHEN CRAIG (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CRAIG
Last Name:HENRY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 MOUNTAIN DRIVE
Mailing Address - Street 2:DR STEPHEN C HENRY HENRY CHIROPRACTIC CLINIC
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2334
Mailing Address - Country:US
Mailing Address - Phone:850-837-2838
Mailing Address - Fax:850-837-7768
Practice Address - Street 1:412 MOUNTAIN DRIVE
Practice Address - Street 2:DR STEPHEN C HENRY HENRY CHIROPRACTIC CLINIC
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2334
Practice Address - Country:US
Practice Address - Phone:850-837-2838
Practice Address - Fax:850-837-7768
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0003017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88323Medicare ID - Type Unspecified
FL88323Medicare UPIN
FL88323Medicare PIN
T85841Medicare UPIN