Provider Demographics
NPI:1740362235
Name:HARRIS, PETER H (DC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:H
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 1:2000 HWY 25 B N
Mailing Address - Street 2:SUITE E1
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543
Mailing Address - Country:US
Mailing Address - Phone:501-206-0408
Mailing Address - Fax:501-206-0410
Practice Address - Street 1:2000 HWY 25B N
Practice Address - Street 2:SUITE E1
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543
Practice Address - Country:US
Practice Address - Phone:501-206-0408
Practice Address - Fax:501-206-0410
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1587111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
5W748OtherBCBS
U89732Medicare UPIN