Provider Demographics
NPI:1992845093
Name:HARRISON, VICKI MARIE (DC)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:MARIE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 NORTH STATE STREET
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008
Mailing Address - Country:US
Mailing Address - Phone:815-544-2732
Mailing Address - Fax:815-544-9722
Practice Address - Street 1:301 NORTH STATE STREET
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008
Practice Address - Country:US
Practice Address - Phone:815-544-2732
Practice Address - Fax:815-544-9722
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL760600Medicare UPIN