Provider Demographics
NPI:1487795910
Name:HARRIS CHIROPRACTIC LLC
Entity type:Organization
Organization Name:HARRIS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-881-2295
Mailing Address - Street 1:1675 E SEMINOLE ST STE H2
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2454
Mailing Address - Country:US
Mailing Address - Phone:417-881-2295
Mailing Address - Fax:417-881-4282
Practice Address - Street 1:1675 E SEMINOLE ST STE H2
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2454
Practice Address - Country:US
Practice Address - Phone:417-881-2295
Practice Address - Fax:417-881-4282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003015247111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO193898OtherBLUE CROSS NUMBER