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General NPI Number Information
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NPI Number | 1376622126
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Entity Type | Individual
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Provider Name | JACK MICHAEL HARLESS D.C.
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Gender | Female
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7677 PARAGON RD # D1
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City | CENTERVILLE FINANCE
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State | OH
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Zip | 45459-4068
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Country | US
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Telephone | 937-435-8480
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Fax |
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Provider Business Mailing Address
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Address Line | 7185 BIGGER LN
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City | CENTERVILLE FINANCE
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State | OH
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Zip | 45459-4907
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Country | US
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Telephone | 937-433-7328
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 3061
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License Number State | OH
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