Provider Demographics
NPI:1205023041
Name:BELCHER, LARRY ALLEN (DC)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:ALLEN
Last Name:BELCHER
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 1:871 KOLU ST
Mailing Address - Street 2:#101
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1456
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:871 KOLU ST
Practice Address - Street 2:#101
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1456
Practice Address - Country:US
Practice Address - Phone:808-242-4764
Practice Address - Fax:808-244-8764
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HID.C. 311111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor