Provider Demographics
NPI:1912045998
Name:HARRIS FAMILY CHIROPRACTIC, P.A.
Entity type:Organization
Organization Name:HARRIS FAMILY CHIROPRACTIC, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-380-6977
Mailing Address - Street 1:17610 MIDWAY RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-6777
Mailing Address - Country:US
Mailing Address - Phone:972-380-6977
Mailing Address - Fax:972-250-1149
Practice Address - Street 1:17610 MIDWAY RD
Practice Address - Street 2:SUITE 124
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-6777
Practice Address - Country:US
Practice Address - Phone:972-380-6977
Practice Address - Fax:972-250-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX-3028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU14143Medicare UPIN
TX601518Medicare ID - Type UnspecifiedMEDICARE TAX ID 752044748