Provider Demographics
NPI:1558512533
Name:LARUE, CHRISTOPHER KELLEY (DC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:KELLEY
Last Name:LARUE
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 1:3330 WESTOWN PKWY
Mailing Address - Street 2:SUITE 15
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1121
Mailing Address - Country:US
Mailing Address - Phone:515-223-1222
Mailing Address - Fax:
Practice Address - Street 1:3330 WESTOWN PKWY
Practice Address - Street 2:SUITE 15
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1121
Practice Address - Country:US
Practice Address - Phone:515-223-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor