Provider Demographics
NPI:1104972660
Name:HARRIS, ANDREW K (DC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:K
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:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32175-0337
Mailing Address - Country:US
Mailing Address - Phone:386-677-9355
Mailing Address - Fax:
Practice Address - Street 1:175 S NOVA RD STE 6A
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-0407
Practice Address - Country:US
Practice Address - Phone:386-677-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC0074901111N00000X
FLCH11213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0872747000OtherKEYSTONE PROVIDER NUMBER
PA0872747000OtherIBC PROVIDER NUMBER
PA921050OtherHIGHMARK PROVIDER NUMBER
PA0872747000OtherKEYSTONE PROVIDER NUMBER
PAU80319Medicare UPIN
PA921050OtherHIGHMARK PROVIDER NUMBER