MEDICARE: MARJORIE HARRISON 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	6055	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0930870	OTHER	AZ	BCBS OF AZ PROVIDER #

General Provider Information

NPI Number	:	1164434684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARJORIE HARRISON DC

Provider Business Mailing Address
First Line	:	6006 N 83RD AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-4119
Country	:	US
Telephone Number	:	623-872-9232
Fax Number	:

Provider Business Practice Location Address
First Line	:	6006 N 83RD AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-4119
Country	:	US
Telephone Number	:	623-872-9232
Fax Number	:

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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