Provider Demographics
NPI:1205946647
Name:HARRIS, MICHAEL MAITLAND (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MAITLAND
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 1:6670 ALESSANDRO BLVD
Mailing Address - Street 2:SUITE A1
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-5356
Mailing Address - Country:US
Mailing Address - Phone:951-776-1693
Mailing Address - Fax:951-776-1694
Practice Address - Street 1:6670 ALESSANDRO BLVD
Practice Address - Street 2:SUITE A1
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-5356
Practice Address - Country:US
Practice Address - Phone:951-776-1693
Practice Address - Fax:951-776-1694
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 20215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU31573Medicare UPIN
CADC0202151Medicare ID - Type UnspecifiedMEDICARE I.D. NUMBER