Provider Demographics
NPI:1932419918
Name:ESTRADA, HENRY (DC,)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:ESTRADA
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 1:95 BOLL ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07014-1501
Mailing Address - Country:US
Mailing Address - Phone:551-795-0831
Mailing Address - Fax:973-282-8584
Practice Address - Street 1:105 VAN HOUTEN AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-5518
Practice Address - Country:US
Practice Address - Phone:551-795-0831
Practice Address - Fax:973-282-8584
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00682200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor