Healthcare Provider Details

I. General information

NPI: 1437445814
Provider Name (Legal Business Name): HARBOUR CHIROPRACTIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 BROADWAY ST
SHERIDAN WY
82801-3916
US

IV. Provider business mailing address

331 BROADWAY ST
SHERIDAN WY
82801-3916
US

V. Phone/Fax

Practice location:
  • Phone: 307-672-0007
  • Fax: 307-672-0776
Mailing address:
  • Phone: 307-672-0007
  • Fax: 307-672-0776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number565
License Number StateWY

VIII. Authorized Official

Name: DR. DAVID M HARBOUR
Title or Position: OWNER/CHIROPRACTOR
Credential: D.C.
Phone: 307-672-0007