Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 722 | WV |
NPI | 1003855669 |
---|---|
Provider Name | Roger Jack Harris JR. |
First Address | Barboursville, WV 25504-1240 |
Second Address | Barboursville, WV 25504-1240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 13/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7600098000 | (05) | WV |
U78080 | (02) | WV |