Provider Demographics
NPI:1083703508
Name:TSUTSUI, LARRY M (DC)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:M
Last Name:TSUTSUI
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 1:2023 N VAN NESS BLVD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-6014
Mailing Address - Country:US
Mailing Address - Phone:559-226-3400
Mailing Address - Fax:559-226-3963
Practice Address - Street 1:2023 N VAN NESS BLVD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-6014
Practice Address - Country:US
Practice Address - Phone:559-226-3400
Practice Address - Fax:559-226-3963
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA770177703111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0165650Medicare UPIN