Provider Demographics
NPI:1447281068
Name:HARMON-URBAN, LETTY LAVERNE (DC)
Entity type:Individual
Prefix:DR
First Name:LETTY
Middle Name:LAVERNE
Last Name:HARMON-URBAN
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:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45715-0235
Mailing Address - Country:US
Mailing Address - Phone:740-678-2700
Mailing Address - Fax:740-678-2777
Practice Address - Street 1:10595 ST. ROUTE 550
Practice Address - Street 2:
Practice Address - City:BARLOW
Practice Address - State:OH
Practice Address - Zip Code:45712
Practice Address - Country:US
Practice Address - Phone:740-678-2700
Practice Address - Fax:740-678-2777
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2931111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH31-1082707OtherTAX ID
OH2289358Medicaid
OHRE9320191Medicare ID - Type UnspecifiedGROUP MEDICARE #
OHHA4011552Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #