Provider Demographics
NPI:1588683858
Name:HARRIS, STEVEN ROGER (DC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ROGER
Last Name:HARRIS
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 1:6602 BARRINGTON RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-3900
Mailing Address - Country:US
Mailing Address - Phone:630-483-7246
Mailing Address - Fax:630-483-7258
Practice Address - Street 1:6602 BARRINGTON RD
Practice Address - Street 2:SUITE C
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-3900
Practice Address - Country:US
Practice Address - Phone:630-483-7246
Practice Address - Fax:630-483-7258
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2490111N00000X
IL038.010908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2034748Medicaid
OH0855301Medicare PIN
67316Medicare UPIN