Provider Demographics
NPI:1831467737
Name:SOURS, JOHN HARVEY (DC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:HARVEY
Last Name:SOURS
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 1:3417 TAMIAMI TRL
Mailing Address - Street 2:SUITE C
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8158
Mailing Address - Country:US
Mailing Address - Phone:941-627-0095
Mailing Address - Fax:941-629-1872
Practice Address - Street 1:3417 TAMIAMI TRL
Practice Address - Street 2:SUITE C
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8158
Practice Address - Country:US
Practice Address - Phone:941-627-0095
Practice Address - Fax:941-629-1872
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10475111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGL984ZOtherINDIVIDUAL PTAN
FLGL732AOtherGROUP'S PTAN
FLGL732AOtherGROUP'S PTAN
FLGL984ZMedicare PIN