Provider Demographics
NPI:1972875136
Name:HARRIS CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:HARRIS CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-654-2200
Mailing Address - Street 1:2234 E LOOP 820
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-4013
Mailing Address - Country:US
Mailing Address - Phone:817-654-2200
Mailing Address - Fax:817-496-6011
Practice Address - Street 1:2234 E LOOP 820
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-4013
Practice Address - Country:US
Practice Address - Phone:817-654-2200
Practice Address - Fax:817-496-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193400000X111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0014615-01Medicaid
TX350015610Medicare PIN
TX0014615-01Medicaid