Provider Demographics
NPI:1326019845
Name:KOENIG, LARRY D (DC)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:D
Last Name:KOENIG
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 1:502 ELM ST
Mailing Address - Street 2:PO BOX 1037
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:52361
Mailing Address - Country:US
Mailing Address - Phone:319-668-2866
Mailing Address - Fax:
Practice Address - Street 1:502 ELM ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:IA
Practice Address - Zip Code:52361
Practice Address - Country:US
Practice Address - Phone:319-668-2866
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA5086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA22600Medicare ID - Type Unspecified