Provider Demographics
NPI:1366500019
Name:HARRISON, GENE SMITH II (DC CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:SMITH
Last Name:HARRISON
Suffix:II
Gender:M
Credentials:DC CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 TAMARACK ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055
Mailing Address - Country:US
Mailing Address - Phone:740-522-1223
Mailing Address - Fax:740-522-1533
Practice Address - Street 1:1951 TAMARACK ROAD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055
Practice Address - Country:US
Practice Address - Phone:740-522-1223
Practice Address - Fax:740-522-1533
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2109111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2525708Medicaid
OH2525708Medicaid
OH4097482Medicare PIN
OH103431702299Medicare ID - Type Unspecified