Provider Demographics
NPI:1528034931
Name:BAIN, LARRY A (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:A
Last Name:BAIN
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 1:7612 N.E. HAZEL DELL AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665
Mailing Address - Country:US
Mailing Address - Phone:360-694-1575
Mailing Address - Fax:360-696-4427
Practice Address - Street 1:7612 NE HAZEL DELL AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665
Practice Address - Country:US
Practice Address - Phone:360-694-1575
Practice Address - Fax:360-696-4427
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00000783111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR17047OtherOR STATE PAYEE # (L&I)
WA2041507Medicaid
WA75953OtherWA STATE PAYEE # (L&I)
WA2041507Medicaid