Provider Demographics
NPI:1124230057
Name:HARRIS, ALISSA BROOKE (DC)
Entity Type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:BROOKE
Last Name:HARRIS
Suffix:
Gender:F
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:PO BOX 1307
Mailing Address - Street 2:
Mailing Address - City:HARPERS FERRY
Mailing Address - State:WV
Mailing Address - Zip Code:25425-1307
Mailing Address - Country:US
Mailing Address - Phone:304-535-3009
Mailing Address - Fax:
Practice Address - Street 1:43 PANAMA STREET
Practice Address - Street 2:
Practice Address - City:HARPERS FERRY
Practice Address - State:WV
Practice Address - Zip Code:25425
Practice Address - Country:US
Practice Address - Phone:304-535-3009
Practice Address - Fax:888-315-4341
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9393291Medicare PIN