Provider Demographics
NPI:1164506986
Name:HARRIS, JAMES WESLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WESLEY
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 1:4217 FAIRWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2454
Mailing Address - Country:US
Mailing Address - Phone:940-696-5150
Mailing Address - Fax:940-696-0475
Practice Address - Street 1:4217 FAIRWAY BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2454
Practice Address - Country:US
Practice Address - Phone:940-696-5150
Practice Address - Fax:940-696-0475
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1682841-01Medicaid
TX8G5330OtherBLUE CROSS BLUE SHIELD INDIVIDUAL PROVIDER NUMBER
TXU37023OtherUPIN
TX5967OtherTEXAS CHIROPRACTIC LICENSE NUMBER
TX0006JFOtherBLUE CROSS BLUE SHIELD GROUP PROVIDER NUMBER
TX8237023OtherBLUE LINK NUMBER
TX1902090236OtherGROUP NPI NUMBER
TX603728Medicare ID - Type Unspecified
TX1682841-01Medicaid
TX8237023OtherBLUE LINK NUMBER