Individual
DR. JACK MICHAEL HARLESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
7677 PARAGON RD # D1, CENTERVILLE FINANCE, OH 45459-4068
(937) 435-8480
Mailing address
7185 BIGGER LN, CENTERVILLE FINANCE, OH 45459-4907
(937) 433-7328
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3061
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
296740715-00
OBWC
OH
Enumeration date
11/03/2006
Last updated
07/08/2007
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