Provider Demographics
NPI:1285741082
Name:HARRIS, JENNIFER JANE (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JANE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 BUTLER BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-8730
Mailing Address - Country:US
Mailing Address - Phone:828-687-1151
Mailing Address - Fax:828-687-1102
Practice Address - Street 1:2115 BUTLER BRIDGE RD
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-8730
Practice Address - Country:US
Practice Address - Phone:828-687-1151
Practice Address - Fax:828-687-1102
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3145111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085MEMedicaid
NCU96165Medicare UPIN
NC2456593BMedicare ID - Type Unspecified