Provider Demographics
NPI:1275593204
Name:GRINDER, LARRY L (DC)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:L
Last Name:GRINDER
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 1:307 CARPENTER DAM RD
Mailing Address - Street 2:LOT E
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-8218
Mailing Address - Country:US
Mailing Address - Phone:501-623-2664
Mailing Address - Fax:501-623-2915
Practice Address - Street 1:307 CARPENTER DAM RD
Practice Address - Street 2:LOT E
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-8218
Practice Address - Country:US
Practice Address - Phone:501-623-2664
Practice Address - Fax:501-623-2915
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1033111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59342Medicare PIN