Healthcare Provider Details

I. General information

NPI: 1740249903
Provider Name (Legal Business Name): THERESA LYNN HARRIS D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 PHOSPHOR AVE
METAIRIE LA
70005-2727
US

IV. Provider business mailing address

722 PHOSPHOR AVE
METAIRIE LA
70005-2727
US

V. Phone/Fax

Practice location:
  • Phone: 504-835-3736
  • Fax: 504-832-8149
Mailing address:
  • Phone: 504-835-3736
  • Fax: 504-832-8149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1236
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: