MEDICARE: DR. KEVIN HARRAH 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
1	111N00000X	Chiropractor	1323	AR

General Provider Information

NPI Number	:	1851323729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN HARRAH D.C.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/08/2007

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