Provider Demographics
NPI:1912933821
Name:HENRIE, TROY (DC)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:HENRIE
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 1:1112 E BROOMFIELD ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-4437
Mailing Address - Country:US
Mailing Address - Phone:989-779-2225
Mailing Address - Fax:989-779-0106
Practice Address - Street 1:1112 E BROOMFIELD ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-4437
Practice Address - Country:US
Practice Address - Phone:989-779-2225
Practice Address - Fax:989-779-0106
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008503111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU97368Medicare UPIN