Provider Demographics
NPI:1487665113
Name:HARRIS, TODD JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:JAMES
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 1:598 NE E ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2350
Mailing Address - Country:US
Mailing Address - Phone:541-479-8081
Mailing Address - Fax:541-956-5261
Practice Address - Street 1:598 NE E ST
Practice Address - Street 2:SUITE D
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2350
Practice Address - Country:US
Practice Address - Phone:541-479-8081
Practice Address - Fax:541-956-5261
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273113111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
350052106OtherRAILROAD MEDICARE
OR11352868OtherOR STATE BUSINESS ID
350052106OtherRAILROAD MEDICARE