Provider Demographics
NPI:1982679825
Name:HARRIS, MARK WILLIAM (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:WILLIAM
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 1:3592 ALOMA AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4012
Mailing Address - Country:US
Mailing Address - Phone:407-706-1420
Mailing Address - Fax:407-673-4534
Practice Address - Street 1:3592 ALOMA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4012
Practice Address - Country:US
Practice Address - Phone:407-706-1420
Practice Address - Fax:407-673-4534
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005746111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6511Medicare ID - Type Unspecified
FLT87702Medicare UPIN