MEDICARE: THERESE JACOBS HENEY D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	870	MA

General Provider Information

NPI Number	:	1710982087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESE JACOBS HENEY D.C.

Provider Business Mailing Address
First Line	:	24 ROCKLAND ST
Second Line	:	UNIT 1
City	:	HANOVER
State	:	MA
Zip	:	02339-2385
Country	:	US
Telephone Number	:	781-826-7397
Fax Number	:	781-826-7469

Provider Business Practice Location Address
First Line	:	24 ROCKLAND ST
Second Line	:	UNIT 1
City	:	HANOVER
State	:	MA
Zip	:	02339-2385
Country	:	US
Telephone Number	:	781-826-7397
Fax Number	:	781-826-7469

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	09/21/2011

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