Provider Demographics
NPI:1023137114
Name:HENRY, WILLIAM GROVER (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GROVER
Last Name:HENRY
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 1:863 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-7205
Mailing Address - Country:US
Mailing Address - Phone:732-493-1533
Mailing Address - Fax:732-493-9390
Practice Address - Street 1:863 W PARK AVE
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-7205
Practice Address - Country:US
Practice Address - Phone:732-493-1533
Practice Address - Fax:732-493-9390
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ 4189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ754042Medicare ID - Type Unspecified