Provider Demographics
NPI:1730471178
Name:HARRIS SPORTS AND FAMILY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:HARRIS SPORTS AND FAMILY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:504-835-3736
Mailing Address - Street 1:722 PHOSPHOR AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-2727
Mailing Address - Country:US
Mailing Address - Phone:504-835-3736
Mailing Address - Fax:504-832-8149
Practice Address - Street 1:722 PHOSPHOR AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-2727
Practice Address - Country:US
Practice Address - Phone:504-835-3736
Practice Address - Fax:504-832-8149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CQ32Medicare PIN