Provider Demographics
NPI:1003987850
Name:HARRIS CHIROPRACTIC CLINIC OF SMITHFIELD
Entity Type:Organization
Organization Name:HARRIS CHIROPRACTIC CLINIC OF SMITHFIELD
Other - Org Name:ANDY T. HARRIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER,DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:T
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-357-5400
Mailing Address - Street 1:607 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-1740
Mailing Address - Country:US
Mailing Address - Phone:757-357-5400
Mailing Address - Fax:
Practice Address - Street 1:607 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-1740
Practice Address - Country:US
Practice Address - Phone:757-357-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA057741OtherANTHEM BLUE CROSS