Provider Demographics
NPI:1942512058
Name:HARRIS, JACOB WT (DC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:WT
Last Name:HARRIS
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 1:417 PEASE RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-3113
Mailing Address - Country:US
Mailing Address - Phone:360-755-3042
Mailing Address - Fax:
Practice Address - Street 1:417 PEASE RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-3113
Practice Address - Country:US
Practice Address - Phone:360-755-3042
Practice Address - Fax:360-539-8648
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 60151328111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor