Provider Demographics
NPI:1992882518
Name:MCHENRY, TROY RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:RICHARD
Last Name:MCHENRY
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 1:1308 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-4126
Mailing Address - Country:US
Mailing Address - Phone:517-783-4201
Mailing Address - Fax:517-783-2652
Practice Address - Street 1:1308 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-4126
Practice Address - Country:US
Practice Address - Phone:517-783-4201
Practice Address - Fax:517-783-2652
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008401111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950C350910OtherBCBS CHIROPRACTOR
MI4308531Medicaid
MI950C350910OtherBCBS CHIROPRACTOR