Provider Demographics
NPI:1235424987
Name:DAVIS, LARRY DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:DEAN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4807 WEST PLANO PARKWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5336
Mailing Address - Country:US
Mailing Address - Phone:972-265-8106
Mailing Address - Fax:972-265-8110
Practice Address - Street 1:4708 W PLANO PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5333
Practice Address - Country:US
Practice Address - Phone:972-265-8106
Practice Address - Fax:972-265-8110
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9005111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor