Provider Demographics
NPI:1346203924
Name:MCKITRICK, LARRY B (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:B
Last Name:MCKITRICK
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 1:201 E ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-3771
Mailing Address - Country:US
Mailing Address - Phone:715-362-5522
Mailing Address - Fax:715-362-5591
Practice Address - Street 1:201 E ANDERSON ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3771
Practice Address - Country:US
Practice Address - Phone:715-362-5522
Practice Address - Fax:715-362-5591
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1279-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38816500Medicaid
WI38816500Medicaid
WI75254Medicare PIN