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General NPI Number Information
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NPI Number | 1003855669
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Entity Type | Individual
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Provider Name | ROGER JACK HARRIS JR. D.C.
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Gender | Male
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 6430 US ROUTE 60 E
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City | BARBOURSVILLE
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State | WV
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Zip | 25504-1240
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Country | US
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Telephone | 304-736-4111
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Fax | 304-736-0334
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Provider Business Mailing Address
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Address Line | 6430 US ROUTE 60 E
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City | BARBOURSVILLE
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State | WV
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Zip | 25504-1240
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Country | US
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Telephone | 304-736-4111
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Fax | 304-736-0334
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 722
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License Number State | WV
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