Provider Demographics
NPI:1770577215
Name:HARRIS, ANDY TRENT (DC)
Entity type:Individual
Prefix:DR
First Name:ANDY
Middle Name:TRENT
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 1:607 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-1740
Mailing Address - Country:US
Mailing Address - Phone:757-357-5400
Mailing Address - Fax:757-357-0657
Practice Address - Street 1:607 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-1740
Practice Address - Country:US
Practice Address - Phone:757-357-5400
Practice Address - Fax:757-357-0657
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2007-12-07
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
VA0104000590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA057742OtherANTHEM BLUE CROSS
VA541502583OtherUNITED HEALTHCARE
VA541502583OtherMAILHANDLERS
VA100353600OtherAMERICAN SPECILITY HEALTH
VA541502583OtherUNITED HEALTHCARE