Provider Demographics
NPI:1659387322
Name:MCGLOTHLIN, LARRY GALE (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:GALE
Last Name:MCGLOTHLIN
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 1:3012 FOREST HILLS CIR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2312
Mailing Address - Country:US
Mailing Address - Phone:434-384-1631
Mailing Address - Fax:434-384-7932
Practice Address - Street 1:3012 FOREST HILLS CIR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2312
Practice Address - Country:US
Practice Address - Phone:343-384-1631
Practice Address - Fax:434-384-7932
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000303111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0104000303OtherSTATE
VAT21418Medicare UPIN