Provider Demographics
NPI:1649263005
Name:HARRISON, ROBERT EUGENE (DC, CCSP)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EUGENE
Last Name:HARRISON
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2939 W CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:W SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-2910
Mailing Address - Country:US
Mailing Address - Phone:916-371-7882
Mailing Address - Fax:916-371-7897
Practice Address - Street 1:2939 W CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:W SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-2910
Practice Address - Country:US
Practice Address - Phone:916-371-7882
Practice Address - Fax:916-371-7897
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 15942111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician