Provider Demographics
NPI:1548393135
Name:ROWE, LARRY ROBERTSON (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:ROBERTSON
Last Name:ROWE
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 1:912 STRAKA TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2534
Mailing Address - Country:US
Mailing Address - Phone:405-632-0003
Mailing Address - Fax:405-632-3773
Practice Address - Street 1:912 STRAKA TER
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2534
Practice Address - Country:US
Practice Address - Phone:405-632-0003
Practice Address - Fax:405-632-3773
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2615111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor