Provider Demographics
NPI:1780689372
Name:HARRIS, DENNIS RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:RAY
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 1:80 FRALEY ST
Mailing Address - Street 2:
Mailing Address - City:KANE
Mailing Address - State:PA
Mailing Address - Zip Code:16735-1325
Mailing Address - Country:US
Mailing Address - Phone:814-837-6493
Mailing Address - Fax:814-837-6493
Practice Address - Street 1:80 FRALEY ST
Practice Address - Street 2:
Practice Address - City:KANE
Practice Address - State:PA
Practice Address - Zip Code:16735-1325
Practice Address - Country:US
Practice Address - Phone:814-837-6493
Practice Address - Fax:814-837-6493
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002517L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008978440003Medicaid
PA0008978440004Medicaid
PA0008978440004Medicaid
PA0008978440003Medicaid