Provider Demographics
NPI:1699901447
Name:KEVIN B HARRISON DC LLC
Entity type:Organization
Organization Name:KEVIN B HARRISON DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-451-6469
Mailing Address - Street 1:20599 NE 105TH TER
Mailing Address - Street 2:
Mailing Address - City:LAKE BUTLER
Mailing Address - State:FL
Mailing Address - Zip Code:32054-5209
Mailing Address - Country:US
Mailing Address - Phone:386-451-6469
Mailing Address - Fax:904-964-9557
Practice Address - Street 1:20599 NE 105TH TER
Practice Address - Street 2:
Practice Address - City:LAKE BUTLER
Practice Address - State:FL
Practice Address - Zip Code:32054-5209
Practice Address - Country:US
Practice Address - Phone:386-451-6469
Practice Address - Fax:904-964-9557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9691111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty