Provider Demographics
NPI:1407149966
Name:HARPER CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:HARPER CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, ND
Authorized Official - Phone:208-476-3158
Mailing Address - Street 1:PO BOX 1061
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544-1061
Mailing Address - Country:US
Mailing Address - Phone:208-476-3158
Mailing Address - Fax:208-476-7818
Practice Address - Street 1:10620 HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-9372
Practice Address - Country:US
Practice Address - Phone:208-476-3158
Practice Address - Fax:208-476-7818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA435111N00000X
IDCHIA1385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1671579Medicare PIN