Provider Demographics
NPI:1346209335
Name:HARBOUR, DAVID MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MATTHEW
Last Name:HARBOUR
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 1:331 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-3916
Mailing Address - Country:US
Mailing Address - Phone:307-672-0007
Mailing Address - Fax:307-672-0776
Practice Address - Street 1:331 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-3916
Practice Address - Country:US
Practice Address - Phone:307-672-0007
Practice Address - Fax:307-672-0776
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY565111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW-306904Medicare ID - Type Unspecified