Healthcare Provider Details

I. General information

NPI: 1265614101
Provider Name (Legal Business Name): COREY STEPHEN HARRIS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 BRAUND ST
ONALASKA WI
54650-8556
US

IV. Provider business mailing address

577 BRAUND ST
ONALASKA WI
54650-8556
US

V. Phone/Fax

Practice location:
  • Phone: 608-406-2488
  • Fax: 608-519-2488
Mailing address:
  • Phone: 608-406-2488
  • Fax: 608-519-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4666
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: