1669641072 NPI number — LARIMORE CHIROPRACTIC, PC

Table of content: (NPI 1669641072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669641072 NPI number — LARIMORE CHIROPRACTIC, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LARIMORE CHIROPRACTIC, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1669641072
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8681
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85738-0681
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-825-3103
Provider Business Mailing Address Fax Number:
520-825-2225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3777 E GOLDER RANCH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85739-9797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-825-3103
Provider Business Practice Location Address Fax Number:
520-825-2225
Provider Enumeration Date:
02/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
TRUDY
Authorized Official Middle Name:
LARIMORE
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
520-825-3103

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4442 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1Z5617 . This is a "HEALTHNET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1024511 . This is a "AMERICAN SPECIALTY HEALTH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1053495796 . This is a "BLUE CROSS BLUE HIELD AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 623176 . This is a "AM CHIRO NETWORK" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 421915 . This is a "COVENTRY" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 2455270 . This is a "AETNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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