Provider Demographics
NPI:1306027719
Name:HARRISON, JEFFREY MATTHEW (LAC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:MATTHEW
Last Name:HARRISON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 LYON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2914
Mailing Address - Country:US
Mailing Address - Phone:415-440-4257
Mailing Address - Fax:415-921-9991
Practice Address - Street 1:1449 LYON ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2914
Practice Address - Country:US
Practice Address - Phone:415-440-4257
Practice Address - Fax:415-921-9991
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL.AC 6536171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist