Healthcare Provider Details

I. General information

NPI: 1205476926
Provider Name (Legal Business Name): TENIKA HENRY-GRAVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2020
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 MALABU DR STE 125A
LEXINGTON KY
40502-3252
US

IV. Provider business mailing address

210 MALABU DR
LEXINGTON KY
40502-3252
US

V. Phone/Fax

Practice location:
  • Phone: 859-229-9999
  • Fax: 859-353-0191
Mailing address:
  • Phone: 859-303-4088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number302482
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: