Provider Demographics
NPI:1891819884
Name:HARRIS, DEAN CHRIS (LMT)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:CHRIS
Last Name:HARRIS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SAINT MARY DR
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-5129
Mailing Address - Country:US
Mailing Address - Phone:618-558-4792
Mailing Address - Fax:618-344-7036
Practice Address - Street 1:1600 LEBANON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221-2491
Practice Address - Country:US
Practice Address - Phone:618-239-6269
Practice Address - Fax:618-239-6269
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist