Provider Demographics
NPI:1063561678
Name:HARRIS, ROBERT H (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28790 CHAGRIN BLVD
Mailing Address - Street 2:SUITE #270
Mailing Address - City:WOODMERE
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4638
Mailing Address - Country:US
Mailing Address - Phone:216-514-1515
Mailing Address - Fax:216-514-1515
Practice Address - Street 1:28790 CHAGRIN BLVD
Practice Address - Street 2:SUITE #270
Practice Address - City:WOODMERE
Practice Address - State:OH
Practice Address - Zip Code:44122-4638
Practice Address - Country:US
Practice Address - Phone:216-514-1515
Practice Address - Fax:216-514-1515
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH985111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHHA4130571Medicare ID - Type Unspecified