Provider Demographics
NPI:1801376868
Name:HARRAKA, DEBRA (DC)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:
Last Name:HARRAKA
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 1:750 LAS GALLINAS AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3432
Mailing Address - Country:US
Mailing Address - Phone:414-444-0945
Mailing Address - Fax:
Practice Address - Street 1:750 LAS GALLINAS AVE STE 202
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3432
Practice Address - Country:US
Practice Address - Phone:415-444-0945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27605111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty