Provider Demographics
NPI:1124118765
Name:HARRIS, JASON JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:JAMES
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 1:1008 EASTVIEW AVE STE 6
Mailing Address - Street 2:P.O. BOX 551
Mailing Address - City:OKOBOJI
Mailing Address - State:IA
Mailing Address - Zip Code:51355-2602
Mailing Address - Country:US
Mailing Address - Phone:712-332-7477
Mailing Address - Fax:712-332-6023
Practice Address - Street 1:1008 EASTVIEW AVE STE 6
Practice Address - Street 2:
Practice Address - City:OKOBOJI
Practice Address - State:IA
Practice Address - Zip Code:51355-2602
Practice Address - Country:US
Practice Address - Phone:712-332-7477
Practice Address - Fax:712-332-6023
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06470111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA44033OtherBLUE CROSS BLUE SHIELD #
IAU88170Medicare UPIN
IA44033OtherBLUE CROSS BLUE SHIELD #