Provider Demographics
NPI:1629153804
Name:WARNER, LARRY EARL JR (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:EARL
Last Name:WARNER
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 1:6217 CHAPEL HILL BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8478
Mailing Address - Country:US
Mailing Address - Phone:972-781-1244
Mailing Address - Fax:972-781-1355
Practice Address - Street 1:6217 CHAPEL HILL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8478
Practice Address - Country:US
Practice Address - Phone:972-781-1244
Practice Address - Fax:972-781-1355
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU80597Medicare UPIN
TX609385Medicare ID - Type Unspecified