Provider Demographics
NPI:1659383529
Name:HARRIS, PAUL M (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
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 1:580 REDBIRD CIR
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-8785
Mailing Address - Country:US
Mailing Address - Phone:920-632-4699
Mailing Address - Fax:920-632-4704
Practice Address - Street 1:580 REDBIRD CIR
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-8785
Practice Address - Country:US
Practice Address - Phone:920-632-4699
Practice Address - Fax:920-632-4704
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4066111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38956100Medicaid
WI201617580012OtherWI BC/BS PIN
WI38956100Medicaid
WI201617580012OtherWI BC/BS PIN