Healthcare Provider Details

I. General information

NPI: 1285741744
Provider Name (Legal Business Name): RICHARD ALVA HENRY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4492 N UNIVERSITY DR
LAUDERHILL FL
33351-4513
US

IV. Provider business mailing address

4492 N. UNIVERSITY DRIVE
LAUDERHILL FL
33351
US

V. Phone/Fax

Practice location:
  • Phone: 954-578-4443
  • Fax: 954-578-4868
Mailing address:
  • Phone: 954-578-4443
  • Fax: 954-578-4868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH 8692
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: