=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023427473
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE BALANCED ATLAS A HARRISON CHIROPRACTIC P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2014
-----------------------------------------------------
Last Update Date | 08/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2121 19TH AVE SUITE 100
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94116-1865
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-242-1472
-----------------------------------------------------
Fax | 415-242-1479
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2121 19TH AVE SUITE 100
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94116-1865
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-242-1472
-----------------------------------------------------
Fax | 415-242-1479
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ALLEN DAYTON HARRISON
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 415-242-1472
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 32679
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------