Basic Information
Provider Information
NPI: 1548409618
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HARRISON
FirstName: STEPHANIE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3900 CLARK RD STE H1
Address2:  
City: SARASOTA
State: FL
PostalCode: 342332366
CountryCode: US
TelephoneNumber: 9419261600
FaxNumber:  
Practice Location
Address1: 3900 CLARK RD STE H1
Address2:  
City: SARASOTA
State: FL
PostalCode: 342332366
CountryCode: US
TelephoneNumber: 9419261600
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/13/2009
LastUpdateDate: 02/13/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
111N00000XCH 9420FLY Chiropractic ProvidersChiropractor 

No ID Information.


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