Provider Demographics
NPI:1164434684
Name:HARRISON, MARJORIE (DC)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:HARRISON
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 1:6006 N 83RD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85303-4119
Mailing Address - Country:US
Mailing Address - Phone:623-872-9232
Mailing Address - Fax:
Practice Address - Street 1:6006 N 83RD AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85303-4119
Practice Address - Country:US
Practice Address - Phone:623-872-9232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6055111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0930870OtherBCBS OF AZ PROVIDER #
AZ68670Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER