Healthcare Provider Details

I. General information

NPI: 1033232160
Provider Name (Legal Business Name): HARLESS FAMILY CHIROPRACTIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

498 E. MONROE ST
DUNDEE MI
48131-0120
US

IV. Provider business mailing address

498 E MONROE ST
DUNDEE MI
48131-1321
US

V. Phone/Fax

Practice location:
  • Phone: 734-529-8600
  • Fax: 734-529-8620
Mailing address:
  • Phone: 734-529-8600
  • Fax: 734-529-8620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301008666
License Number StateMI

VIII. Authorized Official

Name: DR. KENNETH DAVID HARLESS
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 734-529-8600