Healthcare Provider Details

I. General information

NPI: 1841297306
Provider Name (Legal Business Name): ERMEL FLEMING HARRIS JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 10/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 9TH ST STE G
VIENNA WV
26105-2176
US

IV. Provider business mailing address

1100 9TH ST STE G
VIENNA WV
26105-2176
US

V. Phone/Fax

Practice location:
  • Phone: 304-295-4589
  • Fax: 304-295-6676
Mailing address:
  • Phone: 304-295-4589
  • Fax: 304-295-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number226
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: