Provider Demographics
NPI:1033232160
Name:HARLESS FAMILY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:HARLESS FAMILY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HARLESS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-529-8600
Mailing Address - Street 1:498 E MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:MI
Mailing Address - Zip Code:48131-1321
Mailing Address - Country:US
Mailing Address - Phone:734-529-8600
Mailing Address - Fax:734-529-8620
Practice Address - Street 1:498 E. MONROE ST
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:MI
Practice Address - Zip Code:48131-0120
Practice Address - Country:US
Practice Address - Phone:734-529-8600
Practice Address - Fax:734-529-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008666111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E81042OtherBCBS
MIOP28240Medicare ID - Type Unspecified
0P28240001Medicare PIN