Provider Demographics
NPI:1588042410
Name:HARBIN, JILL SUZANNE (DC)
Entity Type:Individual
Prefix:MISS
First Name:JILL
Middle Name:SUZANNE
Last Name:HARBIN
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 1:2114 SMOKETREE TRL NE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35811-2614
Mailing Address - Country:US
Mailing Address - Phone:256-682-0411
Mailing Address - Fax:
Practice Address - Street 1:970 BALCH RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9715
Practice Address - Country:US
Practice Address - Phone:256-527-5564
Practice Address - Fax:256-365-3406
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALJH1200857OtherAMERICAN SPECIALTY HEALTH GROUP
AL025567OtherOPTUM
AL511-64509OtherBLUE CROSS BLUE SHIELD
AL025567OtherOPTUM