Provider Demographics
NPI:1417951807
Name:HARBOUR, JAN A (DC)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:A
Last Name:HARBOUR
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 1:3551 TEAYS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9054
Mailing Address - Country:US
Mailing Address - Phone:304-757-7668
Mailing Address - Fax:304-757-9045
Practice Address - Street 1:3551 TEAYS VALLEY RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9054
Practice Address - Country:US
Practice Address - Phone:304-757-7668
Practice Address - Fax:304-757-9045
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV271111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0131538000Medicaid
WV1022668OtherWORKERS' COMPENSATION
WVHA0454703Medicare ID - Type Unspecified
WV0131538000Medicaid