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NPI Code Detail

MEDICARE: DR. KIM HARRISON SPERRY D.C.

MEDICARE: DR. KIM HARRISON SPERRY D.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
1111N00000XChiropractorDC2864TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1760047771OTHERTXTAX IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1407990625
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KIM HARRISON SPERRY D.C.
Provider Business Mailing Address
First Line : 104 CIRCLE WAY ST
Second Line : SUITE D
City : LAKE JACKSON
State : TX
Zip : 77566-5200
Country : US
Telephone Number : 979-297-0002
Fax Number : 979-297-0002
Provider Business Practice Location Address
First Line : 104 CIRCLE WAY ST
Second Line : SUITE D
City : LAKE JACKSON
State : TX
Zip : 77566-5200
Country : US
Telephone Number : 979-297-0002
Fax Number : 979-297-0002
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2007
Last Update Date : 12/19/2011

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