MEDICARE: MARK WILLIAM HARRIS 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	111NS0005X	Sports Physician Chiropractor	CH0005746	FL

General Provider Information

NPI Number	:	1982679825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK WILLIAM HARRIS D.C.

Provider Business Mailing Address
First Line	:	1876 PIEDMONT PL
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-7609
Country	:	US
Telephone Number	:	407-706-1420
Fax Number	:	407-705-3062

Provider Business Practice Location Address
First Line	:	956 INTERNATIONAL PKWY STE 1580
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5219
Country	:	US
Telephone Number	:	407-706-1420
Fax Number	:	407-705-3062

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	06/18/2024

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