Provider Demographics
NPI:1578624235
Name:HARNISH, JERRY L (DC)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:L
Last Name:HARNISH
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 1:110 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44813-1021
Mailing Address - Country:US
Mailing Address - Phone:419-886-4444
Mailing Address - Fax:419-886-3731
Practice Address - Street 1:110 MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLVILLE
Practice Address - State:OH
Practice Address - Zip Code:44813-1021
Practice Address - Country:US
Practice Address - Phone:419-886-4444
Practice Address - Fax:419-886-3731
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1143111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0603412Medicaid
OHT48261Medicare UPIN
OH0603412Medicaid