Provider Demographics
NPI:1750602835
Name:HARRIS, MITCHELL M (LAC, DIPL OM)
Entity type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:M
Last Name:HARRIS
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Gender:M
Credentials:LAC, DIPL OM
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Mailing Address - Street 1:1534 W ESTES AVE
Mailing Address - Street 2:UNIT #3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-2618
Mailing Address - Country:US
Mailing Address - Phone:312-528-9338
Mailing Address - Fax:312-528-9338
Practice Address - Street 1:3322 N ASHLAND AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-0195
Practice Address - Country:US
Practice Address - Phone:312-528-9338
Practice Address - Fax:312-528-9338
Is Sole Proprietor?:No
Enumeration Date:2010-06-12
Last Update Date:2017-03-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL198.000830171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist