Healthcare Provider Details

I. General information

NPI: 1134189756
Provider Name (Legal Business Name): GREGORY J HARBERS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 N US HIGHWAY 17/92 SUITE B
DEBARY FL
32713-2507
US

IV. Provider business mailing address

58 N US HIGHWAY 17/92 SUITE B
DEBARY FL
32713-2507
US

V. Phone/Fax

Practice location:
  • Phone: 386-668-6321
  • Fax: 386-668-1855
Mailing address:
  • Phone: 386-668-6321
  • Fax: 386-668-1855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH0003194
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: