MEDICARE: DR. VINCENT LAMONTE HENDERSON DC

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

General Provider Information

NPI Number	:	1639156664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT LAMONTE HENDERSON DC

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	07/08/2007

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