Provider Demographics
NPI:1366547960
Name:HARRISON, JOHN SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SCOTT
Last Name:HARRISON
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 1:5110 EDINA INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3008
Mailing Address - Country:US
Mailing Address - Phone:612-267-5435
Mailing Address - Fax:
Practice Address - Street 1:4010 W 65TH ST STE 120
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1724
Practice Address - Country:US
Practice Address - Phone:952-922-8462
Practice Address - Fax:952-922-8462
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDC4112111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN50D98INOtherBCBS PROVIDER NUMBER
MN50D99HAOtherMN PROVIDER NUMBER
MN50D98INOtherBCBS PROVIDER NUMBER