Provider Demographics
NPI:1447257670
Name:HARRIOTT, EDWARD BENJAMIN (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:BENJAMIN
Last Name:HARRIOTT
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 1:2801 ISLE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5180
Mailing Address - Country:US
Mailing Address - Phone:916-741-2041
Mailing Address - Fax:916-304-5617
Practice Address - Street 1:5875 PACIFIC ST STE B1
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-3146
Practice Address - Country:US
Practice Address - Phone:916-741-2041
Practice Address - Fax:916-304-5617
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC28082Medicare ID - Type Unspecified