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General NPI Number Information
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NPI Number | 1679185581
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Entity Type | Individual
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Provider Name | MR. DAVID CHARLES HARRISON
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Gender | Male
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Dates
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Enumeration Date | 08/21/2020
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Last Update Date | 06/02/2022
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Provider Practice Location Address
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Address Line | 2785 N ANKENY BLVD
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City | ANKENY
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State | IA
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Zip | 50023-4705
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Country | US
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Telephone | 816-590-3010
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Fax |
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Provider Business Mailing Address
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Address Line | 709 SE 5TH CT
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City | ANKENY
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State | IA
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Zip | 50021-6407
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Country | US
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Telephone | 816-590-3010
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 114949
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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