Provider Demographics
NPI:1326049297
Name:HERBIG, LARRY JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:JOSEPH
Last Name:HERBIG
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 1:3611 MAIN ST
Mailing Address - Street 2:STE 103
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2321
Mailing Address - Country:US
Mailing Address - Phone:816-561-7035
Mailing Address - Fax:816-960-3890
Practice Address - Street 1:3611 MAIN ST
Practice Address - Street 2:STE 103
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2321
Practice Address - Country:US
Practice Address - Phone:816-561-7035
Practice Address - Fax:816-960-3890
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE004753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4400054OtherUNITED HEALTHCARE
MO4400054OtherUNITED HEALTHCARE