Provider Demographics
NPI:1497970198
Name:HARRIS, EDWIN JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:JOSEPH
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 1:1770 W. HORIZON RIDGE PARKWAY
Mailing Address - Street 2:130
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4833
Mailing Address - Country:US
Mailing Address - Phone:702-617-3330
Mailing Address - Fax:702-617-0837
Practice Address - Street 1:1770 W. HORIZON RIDGE PARKWAY
Practice Address - Street 2:130
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-4833
Practice Address - Country:US
Practice Address - Phone:702-617-3330
Practice Address - Fax:702-617-0837
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor