Provider Demographics
NPI:1477901007
Name:DR. HARRIS - MISSION GROVE CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:DR. HARRIS - MISSION GROVE CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-776-1693
Mailing Address - Street 1:6670 ALESSANDRO BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-5356
Mailing Address - Country:US
Mailing Address - Phone:951-776-1693
Mailing Address - Fax:951-776-1694
Practice Address - Street 1:6670 ALESSANDRO BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-5356
Practice Address - Country:US
Practice Address - Phone:951-776-1693
Practice Address - Fax:951-776-1694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27441111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty