MEDICARE: PLAZA REHAB AND WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1657	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1657	OTHER	AR	ARKANSAS STATE LICENSE
2	5F471	OTHER	AR	BLUE CROSS GROUP ID

General Provider Information

NPI Number	:	1235299223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAZA REHAB AND WELLNESS

Provider Business Mailing Address
First Line	:	307 PLAZA
Second Line	:
City	:	WEST HELENA
State	:	AR
Zip	:	72390-2453
Country	:	US
Telephone Number	:	870-572-9003
Fax Number	:

Provider Business Practice Location Address
First Line	:	307 PLAZA
Second Line	:
City	:	WEST HELENA
State	:	AR
Zip	:	72390-2453
Country	:	US
Telephone Number	:	870-572-9003
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VINCENT L HENDERSON
Credential	:	DC
Telephone Number	:	870-572-9003

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	08/22/2020

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Directions to “PLAZA REHAB AND WELLNESS ” Practice Location

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