Provider Demographics
NPI:1811710213
Name:HENRY, AMY LYN (DC)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:LYN
Last Name:HENRY
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 1:7171 W 60TH ST TRLR 107
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-8913
Mailing Address - Country:US
Mailing Address - Phone:507-822-4289
Mailing Address - Fax:
Practice Address - Street 1:7171 W 60TH ST TRLR 107
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-8913
Practice Address - Country:US
Practice Address - Phone:507-822-4289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA129276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor