Provider Demographics
NPI:1417088774
Name:WILKINS, LARRY E (DC)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:E
Last Name:WILKINS
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 1:372 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666
Mailing Address - Country:US
Mailing Address - Phone:724-547-5030
Mailing Address - Fax:724-547-8306
Practice Address - Street 1:372 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666
Practice Address - Country:US
Practice Address - Phone:724-547-5030
Practice Address - Fax:724-547-8306
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001457L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor