Provider Demographics
NPI:1689600793
Name:HARRIS, TERRY LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LEE
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:TERRY
Other - Middle Name:LEE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:4054 MCKINNEY AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-8231
Mailing Address - Country:US
Mailing Address - Phone:214-922-9220
Mailing Address - Fax:
Practice Address - Street 1:4054 MCKINNEY AVE STE 104
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-8231
Practice Address - Country:US
Practice Address - Phone:214-922-9220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2022-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
600831OtherMEDICARE PTAN
TXT13711Medicare UPIN