Provider Demographics
NPI:1457303364
Name:HARNESS, DAVID AUSTIN I (DIPLNCCAOM)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:AUSTIN
Last Name:HARNESS
Suffix:I
Gender:M
Credentials:DIPLNCCAOM
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:AUSTIN
Other - Last Name:HARNESS
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:DIPLNCCAOM
Mailing Address - Street 1:1065 CHENEY HWY
Mailing Address - Street 2:NA
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-6356
Mailing Address - Country:US
Mailing Address - Phone:321-268-9090
Mailing Address - Fax:321-268-9090
Practice Address - Street 1:1065 CHENEY HWY
Practice Address - Street 2:NA
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-6356
Practice Address - Country:US
Practice Address - Phone:321-268-9090
Practice Address - Fax:321-268-9090
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP602171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist