Provider Demographics
NPI:1659561058
Name:HARRIS, AMY DIONNE (DC)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:DIONNE
Last Name:HARRIS
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 1:2931 RIDGE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6670
Mailing Address - Country:US
Mailing Address - Phone:469-323-3742
Mailing Address - Fax:469-757-0316
Practice Address - Street 1:417 E MAIN ST
Practice Address - Street 2:
Practice Address - City:QUINLAN
Practice Address - State:TX
Practice Address - Zip Code:75474-8989
Practice Address - Country:US
Practice Address - Phone:469-323-3742
Practice Address - Fax:469-757-0316
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9871111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV02266Medicare UPIN