Provider Demographics
NPI:1154567766
Name:HARRISON, WAYNE SCOTT JR (DC)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:SCOTT
Last Name:HARRISON
Suffix:JR
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 1:7200 66TH ST N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-4005
Mailing Address - Country:US
Mailing Address - Phone:727-341-3769
Mailing Address - Fax:
Practice Address - Street 1:7200 66TH ST N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-4005
Practice Address - Country:US
Practice Address - Phone:727-341-3769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-02
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001199111N00000X
FLCFC16111N00000X
RIDCP00282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor