Healthcare Provider Details

I. General information

NPI: 1194872945
Provider Name (Legal Business Name): JEFFREY LORENCE HENRY B.S., M.S., D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 N UNION BLVD SUITE 105
COLORADO SPRINGS CO
80920-4084
US

IV. Provider business mailing address

7730 N UNION BLVD SUITE 105
COLORADO SPRINGS CO
80920-4084
US

V. Phone/Fax

Practice location:
  • Phone: 719-522-1219
  • Fax: 719-522-1648
Mailing address:
  • Phone: 719-522-1219
  • Fax: 719-522-1648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4378
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: