Provider Demographics
NPI:1598258345
Name:HARRIS, SHAWN ROBERT (DACM, LAC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:ROBERT
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 NE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1634
Mailing Address - Country:US
Mailing Address - Phone:541-295-8131
Mailing Address - Fax:
Practice Address - Street 1:845 NE 7TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1634
Practice Address - Country:US
Practice Address - Phone:541-295-8131
Practice Address - Fax:541-295-8235
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDACU-353171100000X
175F00000X
ORAC196721171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath