Provider Demographics
NPI:1629031364
Name:LAUSCH, LARRY LEE JR (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:LEE
Last Name:LAUSCH
Suffix:JR
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 1:11 LONG AVE
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-9795
Mailing Address - Country:US
Mailing Address - Phone:717-733-6886
Mailing Address - Fax:717-733-6996
Practice Address - Street 1:11 LONG AVE
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-9795
Practice Address - Country:US
Practice Address - Phone:717-733-6886
Practice Address - Fax:717-733-6996
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005653L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4674663OtherAETNA
PA1338500OtherHIGHMARK BLUE SHIELD
P00082236OtherRAILROAD
PA50000860OtherCAPITAL BLUE CROSS
P00082236OtherRAILROAD
PALA611823Medicare ID - Type Unspecified