Provider Demographics
NPI:1386717205
Name:HENNIGHAN, ELIZABETH JANE (DC)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JANE
Last Name:HENNIGHAN
Suffix:
Gender:F
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:P. O. BOX 290406
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-0406
Mailing Address - Country:US
Mailing Address - Phone:386-760-6150
Mailing Address - Fax:386-788-1998
Practice Address - Street 1:1398 DUNLAWTON AVE
Practice Address - Street 2:D-4
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-8951
Practice Address - Country:US
Practice Address - Phone:386-760-6150
Practice Address - Fax:386-788-1998
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7773111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55969Medicare ID - Type Unspecified