Healthcare Provider Details

I. General information

NPI: 1215713813
Provider Name (Legal Business Name): NICHOLAS R HENES DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 GREAT OAKS TRL
WADSWORTH OH
44281-9430
US

IV. Provider business mailing address

6321 CHIPPEWA RD
ORRVILLE OH
44667-9146
US

V. Phone/Fax

Practice location:
  • Phone: 330-336-9500
  • Fax:
Mailing address:
  • Phone: 330-466-4609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-05291
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: