MEDICARE: THERESA L 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	CHIR008216	GA
2	111N00000X	Chiropractor	CH10004	FL

General Provider Information

NPI Number	:	1467643080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA L HARRIS DC

Provider Business Mailing Address
First Line	:	2050 SW 7TH PL
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34471-1852
Country	:	US
Telephone Number	:	678-570-6146
Fax Number	:	888-304-5851

Provider Business Practice Location Address
First Line	:	1306 E SILVER SPRINGS BLVD UNIT 102
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34470-6800
Country	:	US
Telephone Number	:	352-622-6622
Fax Number	:	888-304-5851

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

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	11/29/2017

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