Provider Demographics
NPI:1659355154
Name:OEXNER, LARRY (DC)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:OEXNER
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 121552
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34712-1552
Mailing Address - Country:US
Mailing Address - Phone:352-394-4615
Mailing Address - Fax:352-394-7400
Practice Address - Street 1:3721 S HWY 27
Practice Address - Street 2:STE B
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-7640
Practice Address - Country:US
Practice Address - Phone:352-394-4615
Practice Address - Fax:352-394-7400
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH004040111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
88914OtherBCBS
5797332OtherGHI
88914Medicare ID - Type Unspecified
U30833Medicare UPIN