Healthcare Provider Details

I. General information

NPI: 1245320621
Provider Name (Legal Business Name): JOHN HARRIS FOTI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4270 LAKE STREET
BRIDGMAN MI
49106-0489
US

IV. Provider business mailing address

PO BOX 489
BRIDGMAN MI
49106-0489
US

V. Phone/Fax

Practice location:
  • Phone: 269-465-9338
  • Fax: 269-465-9288
Mailing address:
  • Phone: 269-465-9338
  • Fax: 269-465-9288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009249
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: