Provider Demographics
NPI:1770081234
Name:HENLY, MATTHEW WESTON (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:WESTON
Last Name:HENLY
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 1:313 W LIBERTY ST STE 359
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2766
Mailing Address - Country:US
Mailing Address - Phone:717-228-8536
Mailing Address - Fax:
Practice Address - Street 1:313 W LIBERTY ST STE 359
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2766
Practice Address - Country:US
Practice Address - Phone:717-228-8536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC11406111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician