Provider Demographics
NPI:1518045236
Name:COHEN, HARVEY JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:JAY
Last Name:COHEN
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:PO BOX 10560
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96158-3560
Mailing Address - Country:US
Mailing Address - Phone:530-543-3287
Mailing Address - Fax:530-541-2005
Practice Address - Street 1:2155 SOUTH AVE
Practice Address - Street 2:STE 25A
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7038
Practice Address - Country:US
Practice Address - Phone:530-543-3287
Practice Address - Fax:530-541-2005
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 13753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT0353Medicare ID - Type Unspecified
CAT05126Medicare UPIN