1669641072 NPI number — LARIMORE CHIROPRACTIC, PC

Table of Contents

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:
CATALINA MOUNTAIN CHIROPRACTIC
Provider Other Organization Name Type Code:
3
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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