Provider Demographics
NPI:1316923295
Name:HENRY, BRIAN S (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:S
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 1:13825 S 41ST WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-4665
Mailing Address - Country:US
Mailing Address - Phone:480-726-2250
Mailing Address - Fax:480-855-6121
Practice Address - Street 1:600 S DOBSON RD
Practice Address - Street 2:BLDG. E, STE. 38
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5678
Practice Address - Country:US
Practice Address - Phone:480-726-2250
Practice Address - Fax:480-855-6121
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7378111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ84964Medicare PIN
AZU97430Medicare UPIN