MEDICARE: ANDREW K HARRIS DC

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	DC0074901	PA
2	111N00000X	Chiropractor	CH11213	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0872747000	OTHER	PA	KEYSTONE PROVIDER NUMBER
2	0872747000	OTHER	PA	IBC PROVIDER NUMBER
3	921050	OTHER	PA	HIGHMARK PROVIDER NUMBER

General Provider Information

NPI Number	:	1104972660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW K HARRIS DC

Provider Business Mailing Address
First Line	:	PO BOX 337
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32175-0337
Country	:	US
Telephone Number	:	386-677-9355
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 S NOVA RD STE 6A
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-0407
Country	:	US
Telephone Number	:	386-677-9355
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	10/28/2016

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Directions to “ ANDREW K HARRIS DC” Practice Location

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