Provider Demographics
NPI:1427045590
Name:STOGNER, LARRY E (DC)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:E
Last Name:STOGNER
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 1:921 E BROAD AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-4338
Mailing Address - Country:US
Mailing Address - Phone:910-895-6042
Mailing Address - Fax:910-895-3199
Practice Address - Street 1:921 E BROAD AVENUE
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-4338
Practice Address - Country:US
Practice Address - Phone:910-895-6042
Practice Address - Fax:910-895-3199
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08969OtherBCBS
NC8908969Medicaid
NCFH7000210OtherFIRST CAROLINA CARE
NC2447243AMedicare PIN
NC8908969Medicaid
NC350048886Medicare PIN