Provider Demographics
NPI:1073518387
Name:PEPPER, LARRY JOHN JR (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:JOHN
Last Name:PEPPER
Suffix:JR
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 1:2827 ALT US HWY 27 S
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-4972
Mailing Address - Country:US
Mailing Address - Phone:863-386-4325
Mailing Address - Fax:
Practice Address - Street 1:2827 ALT US HWY 27 S
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-4972
Practice Address - Country:US
Practice Address - Phone:863-386-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 7522111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65-0912165Medicare UPIN
FL55754ZMedicare ID - Type Unspecified