Provider Demographics
NPI:1902805310
Name:HARRISON, ANDREW MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MICHAEL
Last Name:HARRISON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3643 MUNICIPAL DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-5434
Mailing Address - Country:US
Mailing Address - Phone:815-759-1100
Mailing Address - Fax:815-344-1208
Practice Address - Street 1:3643 MUNICIPAL DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5434
Practice Address - Country:US
Practice Address - Phone:815-759-1100
Practice Address - Fax:815-344-1208
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400154860OtherMEDICARE PTAN