MEDICARE: HARRAH FAMILY CHIROPRACTIC CLINIC

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	261Q00000X	Clinic/Center	1323	AR

General Provider Information

NPI Number	:	1649459512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARRAH FAMILY CHIROPRACTIC CLINIC

Provider Business Mailing Address
First Line	:	PO BOX 16841
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72403-6714
Country	:	US
Telephone Number	:	870-933-9085
Fax Number	:	870-933-9154

Provider Business Practice Location Address
First Line	:	1007 WINDOVER RD STE C
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401-6009
Country	:	US
Telephone Number	:	870-933-9085
Fax Number	:	870-933-9154

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. KEVIN D HARRAH
Credential	:	D.C.
Telephone Number	:	870-933-9085

Provider Enumeration Date	:	10/29/2007
Last Update Date	:	10/29/2007

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