Provider Demographics
NPI:1396863585
Name:HARRIS, MARSHALL ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:ALLEN
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 1:947 PAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-4003
Mailing Address - Country:US
Mailing Address - Phone:651-771-5540
Mailing Address - Fax:651-645-5107
Practice Address - Street 1:947 PAYNE AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-4003
Practice Address - Country:US
Practice Address - Phone:651-771-5540
Practice Address - Fax:651-645-5107
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3K927COOtherBLUE CROSS BLUE SHIELD