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NPI Code Detail

MEDICARE: KENNETH DAVID HARLESS D.C.

MEDICARE:   KENNETH DAVID HARLESS  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
1111N00000XChiropractor2301008666MI

General Provider Information

NPI Number : 1538119508
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH DAVID HARLESS D.C.
Provider Business Mailing Address
First Line : 119 WATERSTRADT COMMERCE DR
Second Line : SUITE 7
City : DUNDEE
State : MI
Zip : 48131
Country : US
Telephone Number : 734-529-8600
Fax Number : 734-529-8620
Provider Business Practice Location Address
First Line : 119 WATERSTRADT COMMERCE DR
Second Line : SUITE 7
City : DUNDEE
State : MI
Zip : 48131-9695
Country : US
Telephone Number : 734-529-8600
Fax Number : 734-529-8620
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2006
Last Update Date : 07/08/2007

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Directions to “ KENNETH DAVID HARLESS D.C.” Practice Location

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