Provider Demographics
NPI:1336397728
Name:HENRIQUE, JENNIFER REA (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:REA
Last Name:HENRIQUE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W. BULLARD
Mailing Address - Street 2:SUITE #102 PMB 217
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612
Mailing Address - Country:US
Mailing Address - Phone:559-297-4000
Mailing Address - Fax:559-297-4454
Practice Address - Street 1:200 W BULLARD AVE
Practice Address - Street 2:SUITE E-4
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-7610
Practice Address - Country:US
Practice Address - Phone:559-297-4000
Practice Address - Fax:559-297-4454
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24406111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor