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General NPI Number Information
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NPI Number | 1184852295
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Entity Type | Organization
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Legal Business Name | COMMUNITY CHIROPRACTIC CLINIC LLC
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Dates
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Enumeration Date | 06/26/2009
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Last Update Date | 07/01/2009
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Provider Practice Location Address
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Address Line | 2 WORTH CIR SUITE 3
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City | JOHNSON CITY
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State | TN
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Zip | 37601-4304
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Country | US
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Telephone | 423-262-0339
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Fax | 423-262-0340
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Provider Business Mailing Address
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Address Line | 2 WORTH CIR SUITE 3
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City | JOHNSON CITY
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State | TN
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Zip | 37601-4304
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Country | US
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Telephone | 423-262-0339
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Fax | 423-262-0340
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREW DEAN HARRIS
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Credential | D.C.
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Telephone | 423-262-0339
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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 | 2337
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License Number State | TN
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