Provider Demographics
NPI:1639383607
Name:DEVINE, LARRY (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:DEVINE
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:PO BOX 12632
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85267-2632
Mailing Address - Country:US
Mailing Address - Phone:480-332-3400
Mailing Address - Fax:
Practice Address - Street 1:13416 N 32ND ST
Practice Address - Street 2:SUITE 107
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-6000
Practice Address - Country:US
Practice Address - Phone:602-393-7654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5208111N00000X
NVB-570111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0243280OtherBCBSAZ
AZ86-0846626OtherEIIN
AZZDC5208DMedicare ID - Type UnspecifiedMEDICARE
AL0243280OtherBCBSAZ