Provider Demographics
NPI:1598961534
Name:COLE, LARRY W (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:W
Last Name:COLE
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 1:959 WHITE STATION ROAD S
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117
Mailing Address - Country:US
Mailing Address - Phone:901-767-8824
Mailing Address - Fax:901-767-8822
Practice Address - Street 1:959 WHITE STATION ROAD S
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117
Practice Address - Country:US
Practice Address - Phone:901-767-8824
Practice Address - Fax:901-767-8822
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T74775OtherHCFA
2009050OtherBLUE CROSS
T74775Medicare UPIN
T74775OtherHCFA