Provider Demographics
NPI:1568482784
Name:HARRIS, LAURIE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:ANN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15760 VENTURA BLVD
Mailing Address - Street 2:SUITE 820
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-3000
Mailing Address - Country:US
Mailing Address - Phone:818-788-1564
Mailing Address - Fax:818-784-4365
Practice Address - Street 1:15760 VENTURA BLVD
Practice Address - Street 2:SUITE 820
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-3000
Practice Address - Country:US
Practice Address - Phone:818-788-1564
Practice Address - Fax:818-784-4365
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21996111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor