Provider Demographics
NPI:1598831448
Name:LAUDENBACK, LARRY D (DC)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:D
Last Name:LAUDENBACK
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 1:4322 E 66TH ST
Mailing Address - Street 2:SUITE 3I
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1667
Mailing Address - Country:US
Mailing Address - Phone:918-798-5500
Mailing Address - Fax:918-439-0222
Practice Address - Street 1:913 N 161ST E AVE
Practice Address - Street 2:SUITE E
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74116
Practice Address - Country:US
Practice Address - Phone:918-672-2734
Practice Address - Fax:918-439-0222
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3595111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor