Provider Demographics
NPI:1194994897
Name:HARNITCHEK, PAUL E SR (DC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:HARNITCHEK
Suffix:SR
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 1:1535 S D ST
Mailing Address - Street 2:STE 108
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3232
Mailing Address - Country:US
Mailing Address - Phone:909-783-9400
Mailing Address - Fax:909-783-9404
Practice Address - Street 1:295 E CAROLINE ST
Practice Address - Street 2:SUITE D 1
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408
Practice Address - Country:US
Practice Address - Phone:909-783-9400
Practice Address - Fax:909-783-9404
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor