Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 011919 | CA |
NPI | 1063538056 |
---|---|
Provider Name | Dr. Eddie Harrison |
First Address | Yucaipa, CA 92399-2478 |
Second Address | Yucaipa, CA 92399-2478 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 08/07/2007 |