Provider Demographics
NPI:1285644047
Name:HARRIS, RICHARD JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAMES
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 1:115 CARLY LN
Mailing Address - Street 2:
Mailing Address - City:MABANK
Mailing Address - State:TX
Mailing Address - Zip Code:75147-2406
Mailing Address - Country:US
Mailing Address - Phone:417-343-8332
Mailing Address - Fax:
Practice Address - Street 1:1204 S 3RD ST
Practice Address - Street 2:102
Practice Address - City:MABANK
Practice Address - State:TX
Practice Address - Zip Code:75147-7679
Practice Address - Country:US
Practice Address - Phone:903-887-6882
Practice Address - Fax:903-887-3868
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003015247111N00000X
TX8297111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAU61226Medicare UPIN
MO000025616Medicare ID - Type UnspecifiedONE OF THREE NUMBERS