Healthcare Provider Details

I. General information

NPI: 1639156664
Provider Name (Legal Business Name): VINCENT LAMONTE HENDERSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 PLAZA
WEST HELENA AR
72390-2453
US

IV. Provider business mailing address

307 PLAZA
WEST HELENA AR
72390-2453
US

V. Phone/Fax

Practice location:
  • Phone: 870-572-9003
  • Fax:
Mailing address:
  • Phone: 870-572-9003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1657
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: