Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038.012178 | IL |
N | 111NI0013X | Independent Medical Examiner | 038.012178 | IL |
NPI | 1851659361 |
---|---|
Provider Name | Dr. Michael S Harbison |
First Address | Wood River, IL 62095-2001 |
Second Address | Edwardsville, IL 62025-4017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2012 |
Last Update Date | 14/05/2020 |