MEDICARE: HARRIS NECK & BACK CLINIC, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2348	TX
2	208100000X	Physical Medicine & Rehabilitation Physician	2348	TX

General Provider Information

NPI Number	:	1053593236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARRIS NECK & BACK CLINIC, P.C.

Provider Business Mailing Address
First Line	:	3425 HIGHWAY 6
Second Line	:	SUITE 101
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-4439
Country	:	US
Telephone Number	:	281-980-1050
Fax Number	:	281-980-1348

Provider Business Practice Location Address
First Line	:	3425 HIGHWAY 6
Second Line	:	SUITE 101
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-4439
Country	:	US
Telephone Number	:	281-980-1050
Fax Number	:	281-980-1348

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPHEN A. HARRIS
Credential	:	DC
Telephone Number	:	281-980-1050

Provider Enumeration Date	:	11/29/2007
Last Update Date	:	11/04/2008

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