Healthcare Provider Details

I. General information

NPI: 1285787903
Provider Name (Legal Business Name): CHRISTY M HENLEY D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2804 FORUM BLVD STE 1A
COLUMBIA MO
65203-6322
US

IV. Provider business mailing address

2804 FORUM BLVD STE 1A
COLUMBIA MO
65203-6322
US

V. Phone/Fax

Practice location:
  • Phone: 573-446-4949
  • Fax:
Mailing address:
  • Phone: 573-446-4949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number005282
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: