Provider Demographics
NPI:1255330056
Name:STINE, LARRY L (DC, FACO)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:L
Last Name:STINE
Suffix:
Gender:M
Credentials:DC, FACO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-1945
Mailing Address - Country:US
Mailing Address - Phone:540-898-4100
Mailing Address - Fax:540-898-9004
Practice Address - Street 1:117 REDWOOD DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-1945
Practice Address - Country:US
Practice Address - Phone:540-898-4100
Practice Address - Fax:540-898-9004
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2023-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000612111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA207991OtherANTHEM
VAVV4125AMedicare PIN
VA207991OtherANTHEM