=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164066999
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARSHE CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2019
-----------------------------------------------------
Last Update Date | 04/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20800 N JOHN WAYNE PKWY STE 116
-----------------------------------------------------
City | MARICOPA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85139-2728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-350-0074
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20800 N JOHN WAYNE PKWY STE 116
-----------------------------------------------------
City | MARICOPA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85139-2728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-350-0074
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BRANDON HARSHE
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 520-350-0074
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------