Healthcare Provider Details

I. General information

NPI: 1609061985
Provider Name (Legal Business Name): HARRIS CHIROPRACTIC CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

956 INTERNATIONAL PKWY STE 1580
LAKE MARY FL
32746-5219
US

IV. Provider business mailing address

1876 PIEDMONT PL
LAKE MARY FL
32746-7609
US

V. Phone/Fax

Practice location:
  • Phone: 407-706-1420
  • Fax: 407-706-1424
Mailing address:
  • Phone: 407-706-1420
  • Fax: 407-705-3062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH0005746
License Number StateFL

VIII. Authorized Official

Name: DR. MARK WILLIAM HARRIS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 407-706-1420