Provider Demographics
NPI:1518030261
Name:HARRIS, DWIGHT M (DC)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:M
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 1:101 N GREENVILLE AVE.
Mailing Address - Street 2:STE BB
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-9116
Mailing Address - Country:US
Mailing Address - Phone:972-727-6471
Mailing Address - Fax:972-727-1211
Practice Address - Street 1:101 N GREENVILLE AVE
Practice Address - Street 2:STE BB
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-9116
Practice Address - Country:US
Practice Address - Phone:972-727-6471
Practice Address - Fax:972-727-1211
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
601193Medicare ID - Type Unspecified
13716Medicare UPIN