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General NPI Number Information
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NPI Number | 1205375441
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Entity Type | Organization
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Legal Business Name | HARRIS SPORTS CHIROPRACTIC & WELLNESS CENTER
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Dates
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Enumeration Date | 02/21/2017
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 521 W MAIN ST
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City | JENKS
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State | OK
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Zip | 74037-3750
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Country | US
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Telephone | 918-299-6396
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Fax | 918-299-6397
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Provider Business Mailing Address
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Address Line | 521 W MAIN ST
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City | JENKS
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State | OK
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Zip | 74037-3750
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Country | US
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Telephone | 918-299-6396
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Fax | 918-299-6397
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL E HARRIS
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Credential | D.C.
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Telephone | 918-299-6396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 3066
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License Number State | OK
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