Provider Demographics
NPI:1568625499
Name:HARRIS FAMILY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:HARRIS FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:W
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-637-2326
Mailing Address - Street 1:630 ROBERT E LEE AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3211
Mailing Address - Country:US
Mailing Address - Phone:304-637-2326
Mailing Address - Fax:304-637-0404
Practice Address - Street 1:630 ROBERT E LEE AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3211
Practice Address - Country:US
Practice Address - Phone:304-637-2326
Practice Address - Fax:304-637-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV783111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2202090000Medicaid
WVU95141Medicare UPIN
WV2202090000Medicaid