Provider Demographics
NPI:1134335292
Name:HENLINE, MARCUS L (DC)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:L
Last Name:HENLINE
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 1:1000 E CAMELBACK RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-3225
Mailing Address - Country:US
Mailing Address - Phone:602-279-7376
Mailing Address - Fax:602-279-2558
Practice Address - Street 1:1000 E CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-3225
Practice Address - Country:US
Practice Address - Phone:602-279-7376
Practice Address - Fax:602-279-2558
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor