Provider Demographics
NPI:1972678381
Name:HARRIS FAMILY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:HARRIS FAMILY CHIROPRACTIC, P.C.
Other - Org Name:ADVANCED SPINAL CARE AND PAIN RELIEF CENTER OF ARIZONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-938-2425
Mailing Address - Street 1:14231 N 7TH ST
Mailing Address - Street 2:SUITE 5A & 6A
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4360
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14231 N 7TH ST
Practice Address - Street 2:SUITE 5A & 6A
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4360
Practice Address - Country:US
Practice Address - Phone:602-938-2425
Practice Address - Fax:602-547-9710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5651111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========OtherBLUE CROSS BLUE SHIELD
AZ101947Medicare ID - Type UnspecifiedGROUP ID
AZ=========OtherBLUE CROSS BLUE SHIELD
AZ101948Medicare ID - Type UnspecifiedINDIVIDUAL ID