1891825238 NPI number — DR. LARRY WAYNE DEGARMEAUX DC DOCTOR OF CHIROPR

Table of content: DR. LARRY WAYNE DEGARMEAUX DC DOCTOR OF CHIROPR (NPI 1891825238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891825238 NPI number — DR. LARRY WAYNE DEGARMEAUX DC DOCTOR OF CHIROPR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEGARMEAUX
Provider First Name:
LARRY
Provider Middle Name:
WAYNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC DOCTOR OF CHIROPR
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:
1891825238
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 214
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN DALE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-845-8828
Provider Business Mailing Address Fax Number:
304-845-8801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
605 LAFAYETTE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNDSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-845-8828
Provider Business Practice Location Address Fax Number:
304-845-8801
Provider Enumeration Date:
03/06/2007

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:  278 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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