MEDICARE: JAN A HARBOUR 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	111NR0400X	Rehabilitation Chiropractor	271	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1022668	OTHER	WV	WORKERS' COMPENSATION

General Provider Information

NPI Number	:	1417951807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAN A HARBOUR DC

Provider Business Mailing Address
First Line	:	3551 TEAYS VALLEY RD
Second Line	:
City	:	HURRICANE
State	:	WV
Zip	:	25526-9054
Country	:	US
Telephone Number	:	304-757-7668
Fax Number	:	304-757-9045

Provider Business Practice Location Address
First Line	:	3551 TEAYS VALLEY RD
Second Line	:
City	:	HURRICANE
State	:	WV
Zip	:	25526-9054
Country	:	US
Telephone Number	:	304-757-7668
Fax Number	:	304-757-9045

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/08/2007

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Directions to “ JAN A HARBOUR DC” Practice Location

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