Provider Demographics
NPI:1841662160
Name:HARRISON, TODD (DC)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:
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 1:1118 12TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-4663
Mailing Address - Country:US
Mailing Address - Phone:208-989-4015
Mailing Address - Fax:208-416-6886
Practice Address - Street 1:1118 12TH AVE S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-4663
Practice Address - Country:US
Practice Address - Phone:208-989-4015
Practice Address - Fax:208-416-6886
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor