Provider Demographics
NPI:1396875266
Name:HARRISON, CHAD JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:JOSEPH
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 1:4201 38TH ST S
Mailing Address - Street 2:SUITE 207
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104
Mailing Address - Country:US
Mailing Address - Phone:701-893-3160
Mailing Address - Fax:701-893-3161
Practice Address - Street 1:4201 38TH ST S
Practice Address - Street 2:SUITE 207
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104
Practice Address - Country:US
Practice Address - Phone:701-893-3160
Practice Address - Fax:701-893-3161
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13461Medicaid
ND25583OtherBCBS OF ND
MN207M7HAOtherBCBS OF MN
MN666422OtherCHIROCARE MN
ND711361Medicare ID - Type Unspecified
NDU94356Medicare UPIN