Provider Demographics
NPI:1871528000
Name:HARRISON, DEAN J (DC, PTRETIRED)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:J
Last Name:HARRISON
Suffix:
Gender:M
Credentials:DC, PTRETIRED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 HICKS RD
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12832-2606
Mailing Address - Country:US
Mailing Address - Phone:518-810-5775
Mailing Address - Fax:
Practice Address - Street 1:388 HICKS RD
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:NY
Practice Address - Zip Code:12832-2606
Practice Address - Country:US
Practice Address - Phone:518-810-5775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0000536111N00000X
VT040.0059361225100000X
NYX004113-2111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX5M26OtherEMPIRE BCBS
NY6003082OtherMVP
VTHARR00069148OtherBCBSOF VT
NY808682OtherMPN
NY808682OtherMPN
VT000053601Medicare UPIN
NY6003082OtherMVP