Provider Demographics
NPI:1831307693
Name:HARRIS, JOHN OLEN JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:OLEN
Last Name:HARRIS
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4046 N GOLDCLIFF CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-1478
Mailing Address - Country:US
Mailing Address - Phone:480-755-8833
Mailing Address - Fax:602-957-8911
Practice Address - Street 1:2642 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-8243
Practice Address - Country:US
Practice Address - Phone:602-957-8995
Practice Address - Fax:602-957-8911
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor