=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205957891
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HARRISON R PRATER D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7601 CONROY WINDERMERE RD SUITE 204
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32835-2688
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-290-6503
-----------------------------------------------------
Fax | 407-292-5270
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7601 CONROY WINDERMERE RD SUITE 204
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32835-2689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-290-6503
-----------------------------------------------------
Fax | 407-292-5270
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH4188
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------