Provider Demographics
NPI:1740249903
Name:HARRIS, THERESA LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:LYNN
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 1:722 PHOSPHOR AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-2727
Mailing Address - Country:US
Mailing Address - Phone:504-835-3736
Mailing Address - Fax:504-832-8149
Practice Address - Street 1:722 PHOSPHOR AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-2727
Practice Address - Country:US
Practice Address - Phone:504-835-3736
Practice Address - Fax:504-832-8149
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1236111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0272105OtherCIGNA
LA7208303OtherAETNA
LA721516927-BOtherHUMANA
LAG1381OtherBLUE CROSS
LA721516927-BOtherHUMANA
LA7208303OtherAETNA