Provider Demographics
NPI:1558534032
Name:ERMEL F HARRIS JR DC DBA GRAND CENTRAL CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:ERMEL F HARRIS JR DC DBA GRAND CENTRAL CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERMEL
Authorized Official - Middle Name:FLEMING
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:304-295-4589
Mailing Address - Street 1:1100 9TH ST
Mailing Address - Street 2:UNIT G
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-2176
Mailing Address - Country:US
Mailing Address - Phone:304-295-4589
Mailing Address - Fax:304-295-6676
Practice Address - Street 1:1100 9TH ST
Practice Address - Street 2:UNIT G
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-2176
Practice Address - Country:US
Practice Address - Phone:304-295-4589
Practice Address - Fax:304-295-6676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0131404000Medicaid
WV00000172842OtherANTHEM
WV001711327OtherMOUNTAIN STATE BCBS
WV0131404000Medicaid