Provider Demographics
NPI:1104184456
Name:ORDONEZ, LARRY (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:ORDONEZ
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 1:6310 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-1620
Mailing Address - Country:US
Mailing Address - Phone:201-869-6220
Mailing Address - Fax:201-869-5145
Practice Address - Street 1:6310 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-1620
Practice Address - Country:US
Practice Address - Phone:201-869-6220
Practice Address - Fax:201-869-5145
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00697700111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner