Healthcare Provider Details

I. General information

NPI: 1891819884
Provider Name (Legal Business Name): DEAN CHRIS HARRIS LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 LEBANON AVE SUITE 101
BELLEVILLE IL
62221-2491
US

IV. Provider business mailing address

112 SAINT MARY DR
COLLINSVILLE IL
62234-5129
US

V. Phone/Fax

Practice location:
  • Phone: 618-239-6269
  • Fax: 618-239-6269
Mailing address:
  • Phone: 618-558-4792
  • Fax: 618-344-7036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: