Provider Demographics
NPI:1285741744
Name:HENRY, RICHARD ALVA (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALVA
Last Name:HENRY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4492 N. UNIVERSITY DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33351
Mailing Address - Country:US
Mailing Address - Phone:954-578-4443
Mailing Address - Fax:954-578-4868
Practice Address - Street 1:4492 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33351-4513
Practice Address - Country:US
Practice Address - Phone:954-578-4443
Practice Address - Fax:954-578-4868
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 8692111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381791100Medicaid
FL89496OtherBCBS FL
FL89496OtherBCBS FL