1174717763 NPI number — RICHARD A. HENRY, PA

Table of content: (NPI 1174717763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174717763 NPI number — RICHARD A. HENRY, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD A. HENRY, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHIROPRACTIC NATURAL CARE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174717763
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4492 N UNIVERSITY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUDERHILL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33351-4513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-578-4443
Provider Business Mailing Address Fax Number:
954-578-4868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4492 N UNIVERSITY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAUDERHILL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33351-4513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-578-4443
Provider Business Practice Location Address Fax Number:
954-578-4868
Provider Enumeration Date:
08/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HENRY
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
ALVA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-578-4443

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH8692 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133NN1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 89496 . This is a "BCBS FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 381791100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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