Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 271 | WV |
NPI | 1417951807 |
---|---|
Provider Name | Jan A Harbour |
First Address | Hurricane, WV 25526-9054 |
Second Address | Hurricane, WV 25526-9054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0131538000 | (05) | WV |
1022668 | WORKERS' COMPENSATION (01) | WV |
T32295 | (02) | WV |