Provider Demographics
NPI:1376888354
Name:LARIMORE CHIROPRACTIC CLINIC PLLC
Entity Type:Organization
Organization Name:LARIMORE CHIROPRACTIC CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:REX
Authorized Official - Middle Name:J
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-343-6496
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:LARIMORE
Mailing Address - State:ND
Mailing Address - Zip Code:58251-0729
Mailing Address - Country:US
Mailing Address - Phone:701-343-6496
Mailing Address - Fax:701-343-6496
Practice Address - Street 1:320 BOOTH AVE
Practice Address - Street 2:
Practice Address - City:LARIMORE
Practice Address - State:ND
Practice Address - Zip Code:58251-0729
Practice Address - Country:US
Practice Address - Phone:701-343-6496
Practice Address - Fax:701-343-6496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND364111N00000X
ND366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty