Provider Demographics
NPI:1265720650
Name:HARRIS, STEPHANIE SHAWN (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:SHAWN
Last Name:HARRIS
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 1:145 E COLLEGE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5468
Mailing Address - Country:US
Mailing Address - Phone:970-259-5678
Mailing Address - Fax:
Practice Address - Street 1:145 E COLLEGE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5468
Practice Address - Country:US
Practice Address - Phone:970-259-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6264111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor