Healthcare Provider Details

I. General information

NPI: 1053311837
Provider Name (Legal Business Name): CARLA H HARRIS DC DICCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 W MAIN ST
JENKS OK
74037-3750
US

IV. Provider business mailing address

521 W MAIN ST
JENKS OK
74037-3750
US

V. Phone/Fax

Practice location:
  • Phone: 918-299-6396
  • Fax: 918-299-6397
Mailing address:
  • Phone: 918-299-6396
  • Fax: 918-299-6397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3083
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: