Provider Demographics
NPI:1922170844
Name:HARRISON, WILLIAM S (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:S
Last Name:HARRISON
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 1:101 S. MAIN ST.
Mailing Address - Street 2:P.O. BOX 9
Mailing Address - City:LOUISVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62858
Mailing Address - Country:US
Mailing Address - Phone:618-665-3070
Mailing Address - Fax:
Practice Address - Street 1:101 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:IL
Practice Address - Zip Code:62858
Practice Address - Country:US
Practice Address - Phone:618-665-3070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT37794Medicare UPIN
IL680910Medicare ID - Type Unspecified