Provider Demographics
NPI:1043211253
Name:GUINN, LARRY DOUGLAS (DC)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:DOUGLAS
Last Name:GUINN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2477 SHORELAND AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43611-1567
Mailing Address - Country:US
Mailing Address - Phone:419-729-1619
Mailing Address - Fax:419-729-1675
Practice Address - Street 1:2477 SHORELAND AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43611-1567
Practice Address - Country:US
Practice Address - Phone:419-729-1619
Practice Address - Fax:419-729-1675
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH632111N00000X
MI2961111N00000X
GA5111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0319159Medicaid
T46826Medicare UPIN
OHLAO 429291Medicare ID - Type Unspecified