Provider Demographics
NPI:1144091927
Name:HARRISON, DAVID SAMUEL
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SAMUEL
Last Name:HARRISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2870 E BELTLINE AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9704
Mailing Address - Country:US
Mailing Address - Phone:616-363-0902
Mailing Address - Fax:616-363-9730
Practice Address - Street 1:2870 E BELTLINE AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9704
Practice Address - Country:US
Practice Address - Phone:616-363-0902
Practice Address - Fax:616-363-9730
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301401470111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist