Healthcare Provider Details

I. General information

NPI: 1770577215
Provider Name (Legal Business Name): ANDY TRENT HARRIS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date: 03/25/2006
Reactivation Date: 03/31/2006

III. Provider practice location address

607 S CHURCH ST
SMITHFIELD VA
23430-1740
US

IV. Provider business mailing address

607 S CHURCH ST
SMITHFIELD VA
23430-1740
US

V. Phone/Fax

Practice location:
  • Phone: 757-357-5400
  • Fax: 757-357-0657
Mailing address:
  • Phone: 757-357-5400
  • Fax: 757-357-0657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104000590
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: