Provider Demographics
NPI:1619179793
Name:HARSHMAN CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:HARSHMAN CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:HARSHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:417-862-1922
Mailing Address - Street 1:636 W REPUBLIC ROAD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5803
Mailing Address - Country:US
Mailing Address - Phone:417-862-1922
Mailing Address - Fax:417-862-1923
Practice Address - Street 1:636 W REPUBLIC ROAD
Practice Address - Street 2:SUITE 108
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5803
Practice Address - Country:US
Practice Address - Phone:417-862-1922
Practice Address - Fax:417-862-1923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005118111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOCP2562OtherMEDICARE ID TYPE UNSPECIFIED
MOCP2562OtherMEDICARE ID TYPE UNSPECIFIED