Provider Demographics
NPI:1780614222
Name:HARRISON, DAVID K (DC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:K
Last Name:HARRISON
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 1:2870 E BELTLINE AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9704
Mailing Address - Country:US
Mailing Address - Phone:616-363-0902
Mailing Address - Fax:616-363-9730
Practice Address - Street 1:2870 EAST BELTLINE AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525
Practice Address - Country:US
Practice Address - Phone:616-363-0902
Practice Address - Fax:616-363-9730
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005249111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN90870002Medicare PIN