Provider Demographics
NPI:1346329950
Name:BARTELL, LARRY ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:ANTHONY
Last Name:BARTELL
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 1:24837 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1712
Mailing Address - Country:US
Mailing Address - Phone:313-561-1800
Mailing Address - Fax:313-561-2880
Practice Address - Street 1:24837 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1712
Practice Address - Country:US
Practice Address - Phone:313-561-1800
Practice Address - Fax:313-561-2880
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002835111N00000X
FLCH6951111N00000X
MO003982111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP15380Medicare ID - Type Unspecified
T33677Medicare UPIN