Provider Demographics
NPI:1033111307
Name:HARRIS, SCOTT W (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:W
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 1:630 ROBERT E LEE AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3211
Mailing Address - Country:US
Mailing Address - Phone:304-637-2326
Mailing Address - Fax:304-637-0404
Practice Address - Street 1:630 ROBERT E LEE AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3211
Practice Address - Country:US
Practice Address - Phone:304-637-2326
Practice Address - Fax:304-637-0404
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV783111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2202090000Medicaid
WVU95141Medicare UPIN
WV2202090000Medicaid