1558534032 NPI number — ERMEL F HARRIS JR DC DBA GRAND CENTRAL CHIROPRACTIC CENTER

Table of content: (NPI 1558534032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558534032 NPI number — ERMEL F HARRIS JR DC DBA GRAND CENTRAL CHIROPRACTIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERMEL F HARRIS JR DC DBA GRAND CENTRAL CHIROPRACTIC CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558534032
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 9TH ST
Provider Second Line Business Mailing Address:
UNIT G
Provider Business Mailing Address City Name:
VIENNA
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26105-2176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-295-4589
Provider Business Mailing Address Fax Number:
304-295-6676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 9TH ST
Provider Second Line Business Practice Location Address:
UNIT G
Provider Business Practice Location Address City Name:
VIENNA
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26105-2176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-295-4589
Provider Business Practice Location Address Fax Number:
304-295-6676
Provider Enumeration Date:
04/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
ERMEL
Authorized Official Middle Name:
FLEMING
Authorized Official Title or Position:
DOCTOR OF CHIROPRACTIC/OWNER
Authorized Official Telephone Number:
304-295-4589

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  226 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0131404000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00000172842 . This is a "ANTHEM" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001711327 . This is a "MOUNTAIN STATE BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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