Provider Demographics
NPI:1053579086
Name:HARRISON-MCKINNIES, EBONY LATRICE-SHERIE (DC)
Entity type:Individual
Prefix:DR
First Name:EBONY
Middle Name:LATRICE-SHERIE
Last Name:HARRISON-MCKINNIES
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 1:24700 CALAROGA AVE
Mailing Address - Street 2:STE. 102
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-2159
Mailing Address - Country:US
Mailing Address - Phone:510-785-4343
Mailing Address - Fax:510-785-4333
Practice Address - Street 1:24700 CALAROGA AVE
Practice Address - Street 2:STE. 102
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-2159
Practice Address - Country:US
Practice Address - Phone:510-785-4343
Practice Address - Fax:510-785-4333
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30394111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor