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General NPI Number Information
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NPI Number | 1548322571
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Entity Type | Organization
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Legal Business Name | HARRIS CHIROPRACTIC
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 08/29/2007
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Provider Practice Location Address
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Address Line | 580 REDBIRD CIR
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City | DE PERE
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State | WI
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Zip | 54115-8785
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Country | US
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Telephone | 920-632-4699
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Fax | 920-632-4704
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Provider Business Mailing Address
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Address Line | 580 REDBIRD CIR
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City | DE PERE
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State | WI
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Zip | 54115-8785
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Country | US
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Telephone | 920-632-4699
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Fax | 920-632-4704
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL M HARRIS
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Credential | DC
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Telephone | 920-499-4575
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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 | 4066
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License Number State | WI
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