Provider Demographics
NPI:1598740680
Name:PERRY, LARRY DONALD (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:DONALD
Last Name:PERRY
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 1:651 WASHINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701
Mailing Address - Country:US
Mailing Address - Phone:304-522-7323
Mailing Address - Fax:304-529-7684
Practice Address - Street 1:651 WASHINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701
Practice Address - Country:US
Practice Address - Phone:304-522-7323
Practice Address - Fax:304-529-7684
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-12
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3797111N00000X
WV405111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000043463OtherBCBS
350016765OtherRAILROAD MEDICARE
WV000570755OtherBCBS
T89965Medicare UPIN