Provider Demographics
NPI:1538119508
Name:HARLESS, KENNETH DAVID (DC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:DAVID
Last Name:HARLESS
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 1:119 WATERSTRADT COMMERCE DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:DUNDEE
Mailing Address - State:MI
Mailing Address - Zip Code:48131
Mailing Address - Country:US
Mailing Address - Phone:734-529-8600
Mailing Address - Fax:734-529-8620
Practice Address - Street 1:119 WATERSTRADT COMMERCE DR
Practice Address - Street 2:SUITE 7
Practice Address - City:DUNDEE
Practice Address - State:MI
Practice Address - Zip Code:48131-9695
Practice Address - Country:US
Practice Address - Phone:734-529-8600
Practice Address - Fax:734-529-8620
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008666111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor