Provider Demographics
NPI:1417004599
Name:HARRIS, JOEL MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:MICHAEL
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 1:5807 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55807-2459
Mailing Address - Country:US
Mailing Address - Phone:218-624-2452
Mailing Address - Fax:218-624-6048
Practice Address - Street 1:5807 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-2459
Practice Address - Country:US
Practice Address - Phone:218-624-2452
Practice Address - Fax:218-624-6048
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3C165HAOtherBLUE CROSS BLUE SHIELD
MN44-01662OtherMEDICA
MN668328200Medicaid
MN231730OtherAMERICAN CHIROPRACTIC NET
MN44-01662OtherMEDICA
MN3C165HAOtherBLUE CROSS BLUE SHIELD