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Individual

DR. KELLY D HARRIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.C.

Contact information

Practice address
211 S WOODRUFF AVE STE B, IDAHO FALLS, ID 83401-4369
(208) 522-2122
Mailing address
211 S WOODRUFF AVE STE B, IDAHO FALLS, ID 83401-4369
(208) 522-2122

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-511
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
36385
BLUE SHIELD
ID
01
C511-3
BLUE CROSS OF IDAHO
ID
Enumeration date
11/27/2006
Last updated
07/08/2007
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