Provider Demographics
NPI:1932245479
Name:HARRISON, HERDLEY D (DC)
Entity Type:Individual
Prefix:DR
First Name:HERDLEY
Middle Name:D
Last Name:HARRISON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:H.
Other - Middle Name:DENNIS
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 560116
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32856-0116
Mailing Address - Country:US
Mailing Address - Phone:407-375-7170
Mailing Address - Fax:407-481-8501
Practice Address - Street 1:1814 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-7012
Practice Address - Country:US
Practice Address - Phone:407-373-7200
Practice Address - Fax:407-373-7201
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH008751111N00000X
GACHIR5319111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor