Provider Demographics
NPI:1053950469
Name:HENRY, KRISTAL JADE (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTAL
Middle Name:JADE
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 1:401 NEW JERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-5937
Mailing Address - Country:US
Mailing Address - Phone:757-817-2151
Mailing Address - Fax:
Practice Address - Street 1:1745 CITY CENTER BLVD STE B
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-8953
Practice Address - Country:US
Practice Address - Phone:252-338-3206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5119111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor