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General NPI Number Information
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NPI Number | 1174676647
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Entity Type | Organization
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Legal Business Name | HENRY CHIROPRACTIC CLINIC PLLC
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 10/21/2015
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Provider Practice Location Address
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Address Line | 8820 GOODMAN RD
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-2204
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Country | US
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Telephone | 662-890-5454
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Fax | 662-893-8343
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Provider Business Mailing Address
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Address Line | 8820 GOODMAN RD
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-2204
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Country | US
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Telephone | 662-890-5454
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Fax | 662-893-8343
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Authorized Official
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Title or Position | OWNER DOCTOR
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Name | DR. BRIAN K HENRY
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Credential | D.C.
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Telephone | 662-890-5454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 965
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License Number State | MS
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