Healthcare Provider Details

I. General information

NPI: 1417951807
Provider Name (Legal Business Name): JAN A HARBOUR DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 TEAYS VALLEY RD
HURRICANE WV
25526-9054
US

IV. Provider business mailing address

3551 TEAYS VALLEY RD
HURRICANE WV
25526-9054
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-7668
  • Fax: 304-757-9045
Mailing address:
  • Phone: 304-757-7668
  • Fax: 304-757-9045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number271
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: