Provider Demographics
NPI:1992232177
Name:R SCOTT HARRIS
Entity type:Organization
Organization Name:R SCOTT HARRIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:R
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HARIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:830-980-2225
Mailing Address - Street 1:32685 US HIGHWAY 281 N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-3271
Mailing Address - Country:US
Mailing Address - Phone:830-980-2225
Mailing Address - Fax:
Practice Address - Street 1:32685 US HIGHWAY 281 N
Practice Address - Street 2:SUITE 100
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-3271
Practice Address - Country:US
Practice Address - Phone:830-980-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-18
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF005349OtherSTATE FACILITY LICENSE