Basic Information
Provider Information | |||||||||
NPI: | 1205997657 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HENBY | ||||||||
FirstName: | ADAM | ||||||||
MiddleName: | J | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 700688 | ||||||||
Address2: |   | ||||||||
City: | SAN ANTONIO | ||||||||
State: | TX | ||||||||
PostalCode: | 782700688 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2104777654 | ||||||||
FaxNumber: | 2104680682 | ||||||||
Practice Location | |||||||||
Address1: | 600 S TYLER ST STE 2100 | ||||||||
Address2: |   | ||||||||
City: | AMARILLO | ||||||||
State: | TX | ||||||||
PostalCode: | 791012304 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8004046050 | ||||||||
FaxNumber: | 8663133397 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/12/2006 | ||||||||
LastUpdateDate: | 09/09/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | X007569 | NY | N |   | Chiropractic Providers | Chiropractor |   | 111N00000X | 0104557449 | VA | N |   | Chiropractic Providers | Chiropractor |   | 111N00000X | 14199 | TX | Y |   | Chiropractic Providers | Chiropractor |   |
ID Information
ID | Type | State | Issuer | Description | 0104557449 | 01 | VA | VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS | OTHER | 14199 | 01 | TX | TEXAS BOARD OF CHIROPRACTIC | OTHER | 837208 | 01 | NY | EMPIRE | OTHER | 117620 AN | 01 | NY | PREFERRED CARE | OTHER | 7111598 | 01 | NY | AETNA | OTHER | NY07569 | 01 | NY | LANDMARK | OTHER | 007569-9 | 01 | NY | WORKERS COMPENSATION | OTHER | 98L1522 | 01 | NY | MVP | OTHER |