Provider Demographics
NPI:1700327210
Name:HARRIS, PENNY (DC)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 OSBOURNE WAY STE 6
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9693
Mailing Address - Country:US
Mailing Address - Phone:502-867-0073
Mailing Address - Fax:502-867-0560
Practice Address - Street 1:108 OSBOURNE WAY STE 6
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9693
Practice Address - Country:US
Practice Address - Phone:502-867-0073
Practice Address - Fax:502-867-0560
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1362111N00000X
KY276710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100813740Medicaid