1770519696 NPI number — DR. LARRY T MCGUIRE D.C.

Table of content: DR. LARRY T MCGUIRE D.C. (NPI 1770519696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770519696 NPI number — DR. LARRY T MCGUIRE D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGUIRE
Provider First Name:
LARRY
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770519696
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5119 CLOVERCREST CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45040-3629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-422-2598
Provider Business Mailing Address Fax Number:
513-424-3157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4600 ROOSEVELT BOULEVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45044-5158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-422-2598
Provider Business Practice Location Address Fax Number:
513-422-3157
Provider Enumeration Date:
06/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1749 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)