Healthcare Provider Details

I. General information

NPI: 1821741760
Provider Name (Legal Business Name): LEWALIE JULIAN HENLEY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5222 LENOX AVE
JACKSONVILLE FL
32205-4838
US

IV. Provider business mailing address

5222 LENOX AVE
JACKSONVILLE FL
32205-4838
US

V. Phone/Fax

Practice location:
  • Phone: 904-783-0008
  • Fax:
Mailing address:
  • Phone: 904-783-0008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number13827
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: