Provider Demographics
NPI:1801803754
Name:HARRISON, SHIRLENE (DC)
Entity type:Individual
Prefix:
First Name:SHIRLENE
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SHIRLENE
Other - Middle Name:
Other - Last Name:CHING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:123 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-3614
Mailing Address - Country:US
Mailing Address - Phone:775-777-3033
Mailing Address - Fax:775-777-3045
Practice Address - Street 1:123 2ND ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-3614
Practice Address - Country:US
Practice Address - Phone:775-777-3033
Practice Address - Fax:775-777-3045
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB-736111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV39298Medicare PIN