Provider Demographics
NPI:1194872945
Name:HENRY, JEFFREY LORENCE (BS, MS, DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LORENCE
Last Name:HENRY
Suffix:
Gender:M
Credentials:BS, MS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:7730 N UNION BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4084
Mailing Address - Country:US
Mailing Address - Phone:719-522-1219
Mailing Address - Fax:719-522-1648
Practice Address - Street 1:7730 N UNION BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4084
Practice Address - Country:US
Practice Address - Phone:719-522-1219
Practice Address - Fax:719-522-1648
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO4378111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO47223Medicare UPIN