Provider Demographics
NPI:1669472726
Name:HARRIS, PAUL EUGENE (DC CCSP)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EUGENE
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DC CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3750
Mailing Address - Country:US
Mailing Address - Phone:918-299-6396
Mailing Address - Fax:918-299-6397
Practice Address - Street 1:521 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3750
Practice Address - Country:US
Practice Address - Phone:918-299-6396
Practice Address - Fax:918-299-6397
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3066111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
4477256-4Medicare ID - Type Unspecified
T75383Medicare UPIN