Provider Demographics
NPI:1407941024
Name:HARRIS, TIM S (DC)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:S
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 1:930 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3523
Mailing Address - Country:US
Mailing Address - Phone:918-299-5559
Mailing Address - Fax:844-313-8488
Practice Address - Street 1:930 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3523
Practice Address - Country:US
Practice Address - Phone:918-299-5559
Practice Address - Fax:844-313-8488
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3607111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU87958Medicare UPIN